NPIMap

Organization Active NPI

La Maestra Family Clinic, Inc.

Doing business as La Maestra Community Health Centers-Lemon Grove

  • Community Health Clinic/Center
  • Lemon Grove, CA
National Provider Identifier
1891011599
Registry record updated Dec 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
LA MAESTRA FAMILY CLINIC, INC.
Doing business as
La Maestra Community Health Centers-Lemon Grove
Practice address
7967 Broadway
Lemon Grove, CA 91945-1809
Phone
(619) 280-1105
Fax
(619) 285-8134
NPI assigned
Apr 20, 2010
Last updated
Dec 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2010

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

7967 Broadway
Lemon Grove, CA 91945-1809

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1609
Phone (619) 280-1105

Other names 1

  • La Maestra Community Health Centers-Lemon Grove 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
O20120207000604 CA Part A Provider - Federally Qualified Health Center (FQHC) 7113968512 Practice locations: Lemon Grove, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891011599. Details of each certification follow.

Federally qualified health center certification: CCN 551110

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
Feb 7, 2012
Last certification
Feb 7, 2012
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1991 in CA
Enrollment address
7967 Broadway
Lemon Grove, CA 91945-1809

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 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 Director Jan 1, 2018
Graciela Putzoli Individual Corporate DirectorBoard Member Apr 4, 2010
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 Officer Dec 12, 2020
Zara Marselian Individual Corporate OfficerPresident / Ceo May 5, 1990
W-2 Managing EmployeePresident / Ceo May 5, 1990
Operational/Managerial ControlPresident / Ceo May 5, 1990
Samuel Mireles Individual Corporate DirectorBoard Member Apr 4, 2010
Charlene Castro Individual Corporate DirectorBoard Member Apr 4, 2010
Monica de la Torre Individual Corporate DirectorBoard Member Mar 1, 2013
Yessica Quiroz Individual Corporate DirectorBoard Member Apr 4, 2010
Christopher Ewald Individual Corporate DirectorBoard Member Jan 3, 2014
Robert Marquez Individual Corporate Director Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1891011599",
    "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": "921051609",
            "telephone_number": "619-280-1105",
            "fax_number": "619-285-8134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7967 BROADWAY",
            "city": "LEMON GROVE",
            "state": "CA",
            "postal_code": "919451809",
            "telephone_number": "619-280-1105",
            "fax_number": "619-285-8134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA MAESTRA FAMILY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2010-12-14",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Maestra Community Health Centers-Lemon Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lemon Grove, CA

Sources for this page

Verify at the official NPI Registry.