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General NPI Number Information
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NPI Number | 1275073959
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Entity Type | Organization
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Legal Business Name | LA CLINICA DE LA RAZA
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 1501 FRUITVALE AVE
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City | OAKLAND
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State | CA
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Zip | 94601-2322
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Country | US
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Telephone | 510-535-6200
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Fax | 510-535-4167
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Provider Business Mailing Address
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Address Line | 1501 FRUITVALE AVE
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City | OAKLAND
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State | CA
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Zip | 94601-2322
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Country | US
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Telephone | 510-535-6200
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Fax | 510-535-4167
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Authorized Official
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Title or Position | BEHAVIORAL CLINICIAN 1
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Name | MISS CHELA SHANTI RICHHEIMER
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Credential | MFTI
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Telephone | 510-535-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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