NPIMap

Organization Active NPI

La Maestra Family Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • National City, CA
National Provider Identifier
1508949645
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA MAESTRA FAMILY CLINIC, INC.
Practice address
217 Highland Avenue
National City, CA 91950
Phone
(619) 434-7308
Fax
(619) 434-7310
NPI assigned
Oct 23, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Zara Marselian
Title
Chief Executive Officer
Phone
(619) 584-1612

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 39

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

View all 39

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Federally qualified health center certification: CCN 051078

Medicare enrollment files
Legal name
LA MAESTRA FAMILY CLINIC, INC.
Doing business as
LA MAESTRA COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 5, 2007
Last certification
Apr 5, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1991 in CA
Enrollment address
217 Highland Ave
National City, CA 91950-1518

All disclosed owners & managing parties 13

Medicare enrollment files

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 Director Jan 1, 2018
Graciela Putzoli Individual Corporate Director Jan 30, 2007
Mark Boyer Individual Corporate Director Jan 1, 2017
Louie Cazares Individual Corporate Director Jan 1, 2019
Peter Both Gach Individual Corporate Director Jan 1, 2022
Tom Vu Individual Corporate OfficerChief Compliance Officer May 14, 2011
W-2 Managing EmployeeChief Compliance Officer May 14, 2011
Zara Marselian Individual Corporate Director Jan 30, 2007
W-2 Managing Employee Nov 21, 2011
Samuel Mireles Individual Corporate Director Jan 30, 2007
Charlene Castro Individual Corporate Director Jan 30, 2007
Monica de la Torre Individual Corporate Director Jan 1, 2013
Yessica Quiroz Individual Corporate Director Jan 1, 1991
Christopher Ewald Individual Corporate Director Jan 1, 2014
Robert Marquez Individual Corporate Director Jan 1, 2019

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20050516000901 CA Part B Supplier - Clinic/Group Practice 7113968512 Receives reassigned benefits from 118 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: National City, CA; San Diego, CA; Lemon Grove, CA; El Cajon, CA
O20070206000745 CA Part a Provider - Federally Qualified Health Center (FQHC) 7113968512 Practice locations: National City, CA

National Provider Directory

National Provider Directory
Tax ID family
La Maestra Family Clini (40 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

217 Highland Avenue
National City, CA 91950

Mailing address

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 280-4213

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
HAP71142FOtherCASOFP PROVIDER NUMBER
FHC71142FMedicaidCA
EAP00011FOtherCAEAPC PROVIDER NUMBER
BCP71142FOtherCACDP PROVIDER NUMBER

Other names 1

NPPES NPI Registry
  • La Maestra Community Health Centers Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 7, 2021.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1508949645",
    "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": "92105",
            "telephone_number": "619-280-4213",
            "fax_number": "619-281-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 HIGHLAND AVENUE",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "91950",
            "telephone_number": "619-434-7308",
            "fax_number": "619-434-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA MAESTRA FAMILY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "MARSELIAN",
        "authorized_official_first_name": "ZARA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "619-584-1612",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOFP PROVIDER NUMBER",
            "identifier": "HAP71142F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71142F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC PROVIDER NUMBER",
            "identifier": "EAP00011F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDP PROVIDER NUMBER",
            "identifier": "BCP71142F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Maestra Community Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in National City, CA

Sources for this page

Verify at the official NPI Registry.