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NPI Code Detail

MEDICARE: LA CLINICA DE LA RAZA, INC.

MEDICARE: LA CLINICA DE LA RAZA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS1000XStudent Health Clinic/Center
2261QF0400XFederally Qualified Health Center (FQHC)550000036CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21851522015OTHERCAFPACT

General Provider Information

NPI Number : 1851522015
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA CLINICA DE LA RAZA, INC.
Provider Business Mailing Address
First Line : PO BOX 22210
Second Line :
City : OAKLAND
State : CA
Zip : 94623-2210
Country : US
Telephone Number : 510-535-4000
Fax Number : 510-535-4189
Provider Business Practice Location Address
First Line : 1926 - 19TH AVENUE
Second Line :
City : OAKLAND
State : CA
Zip : 94606-4126
Country : US
Telephone Number : 510-879-2953
Fax Number : 510-879-2956
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MS. JANE GARCIA
Credential :
Telephone Number : 510-535-4000
Provider Enumeration Date : 08/05/2009
Last Update Date : 10/17/2019

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Directions to “LA CLINICA DE LA RAZA, INC. ” Practice Location

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