NPIMap

Organization Active NPI

La Maestra Family Clinic, Inc.

Doing business as La Maestra Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1265831960
Registry record updated Aug 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
090000378 Issued in CA
Legal business name
LA MAESTRA FAMILY CLINIC, INC.
Doing business as
La Maestra Community Health Centers
Practice address
4171 Fairmount Ave
San Diego, CA 92105-1609
Phone
(619) 584-1612
NPI assigned
Aug 19, 2014
Last updated
Aug 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Zara Marselian
Title
Ceo
Phone
(619) 584-1612

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 090000378 CA Primary

Addresses

Primary practice location

4171 Fairmount Ave
San Diego, CA 92105-1609

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1608
Phone (619) 584-1612

Other names 1

  • La Maestra Community Health Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250226000414 CA Part A Provider - Federally Qualified Health Center (FQHC) 7113968512 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265831960. Details of each certification follow.

Federally qualified health center certification: CCN A01979

Legal name
LA MAESTRA FAMILY CLINIC, INC.
Doing business as
LA MAESTRA COMMUNITY HEALTH CENTERS- HOPE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 29, 2025
Last certification
Aug 29, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Mar 17, 2014 in CA
Enrollment address
4171 Fairmount Ave
San Diego, CA 92105-1609

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
La Maestra Family Clinic in41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pida Kongphouthone Individual Corporate DirectorBoard Member Jan 1, 2018
Graciela Putzoli Individual Corporate DirectorBoard Member Jan 1, 1999
Mark Boyer Individual Corporate DirectorBoard Member Jan 1, 2017
Louie Cazares Individual Corporate DirectorBoard Member Jan 1, 2019
Peter Both Gach Individual Corporate DirectorBoard Member Jan 1, 2022
Tom Vu Individual Corporate OfficerChief of Corporate Compliance May 6, 2011
W-2 Managing EmployeeChief of Corporate Compliance May 6, 2011
Zara Marselian Individual Corporate OfficerCeo May 6, 2011
W-2 Managing EmployeeCeo May 6, 2011
Samuel Mireles Individual Corporate DirectorBoard Member Jan 1, 1997
Charlene Castro Individual Corporate DirectorBoard Member Jan 1, 2002
Monica de la Torre Individual Corporate OfficerBoard Member Jan 1, 2013
Yessica Quiroz Individual Corporate DirectorBoard Member Jan 1, 1991
Christopher Ewald Individual Corporate DirectorBoard Member Jan 1, 2014
Robert Marquez Individual Corporate DirectorBoard Member Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408406400000",
    "number": "1265831960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-584-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4171 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051609",
            "telephone_number": "619-584-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA MAESTRA FAMILY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2014-08-19",
        "status": "A",
        "authorized_official_last_name": "MARSELIAN",
        "authorized_official_first_name": "ZARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-584-1612"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "090000378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Maestra Community Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.