Healthcare Provider Details

I. General information

NPI: 1366531428
Provider Name (Legal Business Name): THE CENTRAL AMERICAN RESOURCE CENTER OF NORTHER CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MISSION ST STE 101
SAN FRANCISCO CA
94110-4581
US

IV. Provider business mailing address

3101 MISSION ST STE 101
SAN FRANCISCO CA
94110-4581
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-4400
  • Fax: 415-824-2806
Mailing address:
  • Phone: 415-642-4400
  • Fax: 415-824-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: RONALD A MUNOZ
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 415-642-4400