NPIMap

Organization Active NPI

La Maestra Family Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1780376012
Registry record updated May 24, 2023
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
4074 Fairmount Ave
San Diego, CA 92105-1608
Phone
(619) 584-1612
NPI assigned
May 24, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Tom Vu
Title
Executive Director
Phone
(619) 972-4165

Specialties & licenses 1

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

Addresses

Primary practice location

4074 Fairmount Ave
San Diego, CA 92105-1608

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 CA2 enrollments

Enrollment records 2

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
O20250927000045 CA Part A Provider - Federally Qualified Health Center (FQHC) 7113968512 Practice locations: San Diego, CA

Federally qualified health center certification: CCN A11031

Legal name
LA MAESTRA FAMILY CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 2, 2025
Last certification
Sep 2, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4074 Fairmount Ave
San Diego, CA 92105-1608

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
La Maestra Family Clini40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

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

View all 39

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Julia Macouzet Individual Corporate Director Feb 7, 2025
Pida Kongphouthone Individual Corporate Director Jan 1, 2018
Graciela Putzoli Individual Corporate Director Nov 8, 2004
Mark Boyer Individual Corporate Director Jan 1, 2017
Jeffrey Neumann Individual Other Jun 27, 2017
Louie Cazares Individual Corporate Director Jan 1, 2019
Peter Both Gach Individual Corporate Director Jan 1, 2022
Tom Vu Individual Corporate Officer May 14, 2011
W-2 Managing Employee May 14, 2011
Zara Marselian Individual Corporate Officer Jul 22, 1991
W-2 Managing Employee Jul 22, 1991
Operational/Managerial ControlChief Executive Officer Jul 22, 1991
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 Aug 16, 2010
Christopher Ewald Individual Corporate Director Jan 1, 2014
Robert Marquez Individual Corporate Director Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1684886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1780376012",
    "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",
            "fax_number": "619-281-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4074 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-584-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA MAESTRA FAMILY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-06",
        "status": "A",
        "authorized_official_last_name": "VU",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "619-972-4165"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "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.