Healthcare Provider Details

I. General information

NPI: 1780606632
Provider Name (Legal Business Name): LA CLINICA DE LA RAZA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920A SONOMA BLVD
VALLEJO CA
94590-3879
US

IV. Provider business mailing address

1515 FRUITVALE AVE
OAKLAND CA
94601-2322
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-2000
  • Fax: 707-644-3507
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. JANE GARCIA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 510-535-4000