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NPI Code Detail

MEDICARE: LA CLINICA DE LA RAZA INC

MEDICARE: LA CLINICA DE LA RAZA INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS1000XStudent Health Clinic/Center
2261QF0400XFederally Qualified Health Center (FQHC)550000169CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105-1821OTHERCAMEDICARE PART A
4ZZZ2118ZOTHERCAMEDICARE PART B

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2HAP71125FOTHERCAFPACT
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013085778
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA CLINICA DE LA RAZA INC
Provider Business Mailing Address
First Line : PO BOX 22210
Second Line :
City : OAKLAND
State : CA
Zip : 94623-2210
Country : US
Telephone Number : 510-535-4000
Fax Number : 510-535-4189
Provider Business Practice Location Address
First Line : 4351 BROADWAY
Second Line :
City : OAKLAND
State : CA
Zip : 94611-4612
Country : US
Telephone Number : 510-879-1907
Fax Number : 510-879-1999
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MS. JANE GARCIA
Credential :
Telephone Number : 510-535-4000
Provider Enumeration Date : 12/01/2006
Last Update Date : 04/30/2024

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Directions to “LA CLINICA DE LA RAZA INC ” Practice Location

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