Healthcare Provider Details

I. General information

NPI: 1689863516
Provider Name (Legal Business Name): NATIVE AMERICAN HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 03/30/2022
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 INTERNATIONAL BLVD ROOM 101
OAKLAND CA
94601-2228
US

IV. Provider business mailing address

2920 INTERNATIONAL BLVD ROOM 101
OAKLAND CA
94601-2228
US

V. Phone/Fax

Practice location:
  • Phone: 510-485-5948
  • Fax: 510-485-5949
Mailing address:
  • Phone: 510-485-5948
  • Fax: 510-485-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number140000155
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number140000155
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: ADRIAN A MARCUS-FLORES
Title or Position: CREDENTIALING & LICENSING ASSOCIATE
Credential:
Phone: 510-485-5906