Provider Demographics
NPI:1659490308
Name:LA MAESTRA FAMILY CLINIC INC.
Entity Type:Organization
Organization Name:LA MAESTRA FAMILY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEJANDRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AREIZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-507-7756
Mailing Address - Street 1:4185 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1609
Mailing Address - Country:US
Mailing Address - Phone:619-584-1612
Mailing Address - Fax:619-578-2589
Practice Address - Street 1:4305 UNIVERSITY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1645
Practice Address - Country:US
Practice Address - Phone:619-501-1235
Practice Address - Fax:619-501-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71118FMedicaid