Provider Demographics
NPI:1891011599
Name:LA MAESTRA FAMILY CLINIC, INC.
Entity type:Organization
Organization Name:LA MAESTRA FAMILY CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4060 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:619-280-1105
Mailing Address - Fax:619-285-8134
Practice Address - Street 1:7967 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1809
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:2010-04-20
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health