1467950550 NPI number — LA MAESTRA FAMILY CLINIC, INC.

Table of content: MR. TIMOTHY FRANK RIZZO RNFA (NPI 1841779790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467950550 NPI number — LA MAESTRA FAMILY CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA MAESTRA FAMILY CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467950550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4060 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92105-1608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-972-4165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-255-9164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VU
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF CORPORATE COMPLIANCE
Authorized Official Telephone Number:
619-269-1292

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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