Provider Demographics
NPI:1437478351
Name:LA MAESTRA FAMILY CLINIC, INC
Entity Type:Organization
Organization Name:LA MAESTRA FAMILY CLINIC, INC
Other - Org Name:LA MAESTRA COMMUNITY HEALTH CENTERS-LEMON GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-584-1612
Mailing Address - Street 1:7967 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1809
Mailing Address - Country:US
Mailing Address - Phone:619-741-7423
Mailing Address - Fax:619-713-2589
Practice Address - Street 1:4185 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1609
Practice Address - Country:US
Practice Address - Phone:619-280-1105
Practice Address - Fax:619-285-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)