Healthcare Provider Details

I. General information

NPI: 1194868133
Provider Name (Legal Business Name): INSTITUTO FAMILIAR DE LA RAZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 MISSION ST
SAN FRANCISCO CA
94110-3917
US

IV. Provider business mailing address

943 MADRID ST
SAN FRANCISCO CA
94112-3838
US

V. Phone/Fax

Practice location:
  • Phone: 415-229-0550
  • Fax:
Mailing address:
  • Phone: 514-756-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA MARIE ESCOBAR
Title or Position: COUNSELOR
Credential:
Phone: 415-229-0550