Organization
SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Active
Other names
Ravenswood Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUISA M. BUADA RN, MPH (CHIEF EXECUTIVE OFFICER)
(650) 330-7410
Entity
Organization
Contact information
Practice address
1807 BAY ROAD, EAST PALO ALTO, CA 94303-1312
(650) 330-7407
(650) 321-1560
Mailing address
1885 BAY RD, EAST PALO ALTO, CA 94303-1312
(650) 330-7410
(650) 321-1156
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
APPLIED FOR
CA
261QF0400X
Federally Qualified Health Center (FQHC)
APPLIED FOR
CA
Other
Enumeration date
09/14/2009
Last updated
08/31/2015
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