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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
1291U00000XClinical Medical LaboratoryCLIA05D0921215CA
23336C0002XClinic PharmacyDEA5895240CA
3171M00000XCase Manager/Care Coordinator
4261QF0400XFederally Qualified Health Center (FQHC)140000708CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427070374
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 : 510-238-5400
Fax Number : 510-238-8015
Provider Business Practice Location Address
First Line : 1030 INTERNATIONAL BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94606-3730
Country : US
Telephone Number : 510-238-5400
Fax Number : 510-238-8015
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MS. JANE GARCIA
Credential :
Telephone Number : 510-535-4000
Provider Enumeration Date : 07/23/2006
Last Update Date : 04/06/2022

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

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