LA MAESTRA FAMILY CLINIC, INC. (NPI# 1073177739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073177739 |
| Entity Type | Organization |
| Organization Name | LA MAESTRA FAMILY CLINIC, INC. |
| Practice Address |
4060 Fairmount Ave San Diego CA 92105-1608 |
| Practice Telephone | 6195841612 |
| Practice Fax Number | 6192816738 |
| Mailing Telephone | 6195841612 |
| Mailing Fax Number | 6192816738 |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | TOM VU (CHIEF OF CORPORATE COMPLIANCE) |
| Authorized Official Telephone | 6192691292 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC70472G | 05 |
| Other Name | Type Code |
|---|---|
| Health Home Care Management Program | Other Name - Individual/Organization |
| La Maestra Community Health Centers | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326578774 | La Maestra Family Clinic, Inc. | Pharmacy | 165 S 1st St Ste 1b, El Cajon, CA 92019-4795 | 2017-06-19 |
| 1912301110 | La Maestra Family Clinic, Inc. | Physician Assistant | 259 Seldovia Street, Box 206, Seldovia, AK 99663-0206 | 2014-10-16 |
| 1265831960 | La Maestra Family Clinic, Inc. | Clinic/Center | 4171 Fairmount Ave, San Diego, CA 92105-1609 | 2014-08-19 |
| 1508949645 | La Maestra Family Clinic, Inc. | Clinic/Center | 217 Highland Avenue, National City, CA 91950 | 2006-10-23 |
| 1467950550 | La Maestra Family Clinic, Inc. | Pharmacy | 209 Highland Ave, National City, CA 91950-1518 | 2018-01-24 |
| 1467718791 | La Maestra Family Clinic, Inc. | Clinic/Center | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2012-04-11 |
| 1891011599 | La Maestra Family Clinic, Inc. | Clinic/Center | 7967 Broadway, Lemon Grove, CA 91945-1809 | 2010-04-20 |
| 1609849074 | La Maestra Family Clinic, Inc. | Clinic/Center | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2006-02-08 |
| Street Address |
4060 FAIRMOUNT AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92105-1608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932104981 | Sombath Senethong | Family Medicine | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2005-06-16 |
| 1811594286 | Nathanael Jonathan Luna | Pharmacist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2020-10-07 |
| 1184243420 | Soona Ko | Student in an Organized Health Care Education/Training Program | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2020-04-15 |
| 1780233098 | Cristina L Kim | Nurse Practitioner | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2019-09-09 |
| 1275189110 | Jessica Wilson | Nurse Practitioner | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2019-08-15 |
| 1982181772 | Vahid Niki | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2018-07-24 |
| 1417446477 | Kellie Ramsey | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2018-05-05 |
| 1528586716 | Emilia Kodiath | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2017-09-07 |
| 1659814648 | Iran Felix | Nurse Practitioner | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2016-11-23 |
| 1265892814 | Marina Markova | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2016-02-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851934798 | Point Loma Nazarene University | Nurse Practitioner | Point Loma Nazarene University Health Promotion Center, 4101 University Avenue, San Diego, CA 92105 | 2019-10-23 |
| 1104478809 | Kristin Lynn Nichols | Counselor | 4823 El Cajon Blvd Suite #115, San Diego, CA 92105 | 2019-07-12 |
| 1205343076 | Momentum Learning | Counselor | 3720 El Cajon Blvd., Sd, CA 92105 | 2018-01-03 |
| 1306352695 | Nathan Hien Le, Dds. Inc | Dentist | 4170 Fairmount Ave., San Diego, CA 92105 | 2017-12-21 |
| 1073038071 | Aika Mary Erlandson | Student in an Organized Health Care Education/Training Program | 5296 University Ave. Suite F-2, San Diego, CA 92105 | 2017-08-10 |
| 1457872178 | Ride-in Transport LLC | Non-emergency Medical Transport (VAN) | 4061 Fairmount Ave, San Diego, CA 92105 | 2017-07-03 |
| 1598205346 | Ahmed Mooge | Ambulance | 4061 Fairmout Ave, San Diego, CA 92105 | 2017-02-27 |
| 1083152748 | Rady Childrens Hospital-san Diego | Psychiatric Unit | 4305 University Avenue, Suite 150, San Diego, CA 92105 | 2017-02-02 |
| 1730634098 | Med Specialty Sai Inc. | Pharmacy | 4153 University Avenue, Suite B, San Diego, CA 92105 | 2016-08-16 |
| 1568857464 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 4074 Fairmount Avenue, Suite B, San Diego, CA 92105 | 2015-03-30 |
| Find all providers in zip 92105 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902364904 | Occupational Health Centers of California, A Medical Corporation | Clinic/Center | 5353 Mission Center Rd Ste 115, San Diego, CA 92108-1304 | 2019-03-08 |
| 1639569098 | Uc San Diego Foundation | Clinic/Center | 4041 T St, San Diego, CA 92113-1808 | 2015-01-23 |
| 1598155962 | Uc San Diego Foundation | Clinic/Center | 1561 Thomas Ave, San Diego, CA 92109-4346 | 2015-01-23 |
| 1982006573 | Caos, A Medical Corporation | Clinic/Center | 2655 Camino Del Rio, Suite #330, San Diego, CA 92108-1633 | 2014-09-25 |
| 1578965471 | Uc San Diego Foundation | Clinic/Center | 1420 3rd Ave, San Diego, CA 92101-3103 | 2014-09-23 |
| 1942616255 | Malchow Chiropractic Inc | Clinic/Center | 12145 Alta Carmel Ct, San Diego, CA 92128-3842 | 2014-07-08 |
| 1093157604 | Fluvaccine.org | Clinic/Center | 970 Turquoise St, Suite B, San Diego, CA 92109-1141 | 2013-07-24 |
| 1679760714 | Morteza Mirkarimi | Clinic/Center | 3058 Clairemont Dr, San Diego, CA 92117-6830 | 2007-10-03 |
| 1316978620 | John J. Doria | Clinic/Center | 3003 4th Ave, San Diego, CA 92103-5801 | 2006-07-05 |
| 1861969677 | Awesome Healing Acupuncture | Clinic/Center | 2535 Camino Del Rio S Ste 230, San Diego, CA 92108-3795 | 2018-10-30 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.