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General NPI Number Information
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NPI Number | 1528356102
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Entity Type | Organization
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Legal Business Name | LA CLINICA DE LA RAZA TRANSIENT VILLAGE
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 3451 E 12TH ST
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City | OAKLAND
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State | CA
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Zip | 94601-3463
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Country | US
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Telephone | 510-535-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3451 E 12TH ST
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City | OAKLAND
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State | CA
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Zip | 94601-3463
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Country | US
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Telephone | 510-535-4000
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Fax |
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Authorized Official
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Title or Position | CHIEF DENTAL DIRECTOR
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Name | DR. ARIANE TERLET
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Credential | DDS
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Telephone | 510-535-4713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 25801
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License Number State | CA
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