La Maestra Family Clinic, INC.

Clinic/Center, Federally Qualified Health Center (FQHC) in San Diego, CA. Organization (NPI-2).

NPI number1124763438

StatusActive

Last updated in NPPESMay 2, 2022

Details

NPI: 1124763438
Entity type: Organization (NPI-2)
Legal business name: La Maestra Family Clinic, INC.
Organization subpart: No
Enumeration date: May 2, 2022
Certification date: Apr 14, 2022
Last updated: May 2, 2022

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QF0400X	Clinic/Center, Federally Qualified Health Center (FQHC)	–	–	Yes

Other names

La Maestra Community Health Centers (Doing Business As)

Practice location

4179 Fairmount Ave
San Diego, CA 92105-1609

Phone 619-285-7097 · Fax 619-564-8140

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1608

Phone 619-584-1612 · Fax 619-281-6738

Authorized official

Tom Vu
Executive Director
6199724165

Is something wrong?

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Other Federally Qualified Health Center (FQHC) providers in San Diego, CA

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