MEDICARE: LA CLINICA DE LA RAZA

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
1	363L00000X	Nurse Practitioner	95003462	CA

General Provider Information

NPI Number	:	1194185470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA CLINICA DE LA RAZA

Provider Business Mailing Address
First Line	:	PO BOX 22210
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94623-2210
Country	:	US
Telephone Number	:	510-535-3900
Fax Number	:	510-535-4128

Provider Business Practice Location Address
First Line	:	2000 SIERRA RD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-2905
Country	:	US
Telephone Number	:	925-363-2000
Fax Number	:	925-363-2006

Authorized Official
Title or Position	:	HR SPECIALIST
Name	:	ALFA JULES
Credential	:
Telephone Number	:	510-535-2965

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	03/01/2016

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Directions to “LA CLINICA DE LA RAZA ” Practice Location

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