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Organization

THE DAVIS STREET COMMUNITY CENTER INCORPORATED

Active
Other names
Davis Street Primary Care Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
ROSALIA AQUINO MCMILLEN (CHIEF FISCAL OFFICER)
(510) 347-4620
Entity
Organization

Contact information

Practice address
3081 TEGARDEN, SAN LEANDRO, CA 94577-5720
(510) 347-4620
(510) 486-4486
Mailing address
3081 TEGARDEN STREET, SAN LEANDRO, CA 94577-5720
(510) 347-4620
(510) 486-4486

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
261QD0000X
Dental Clinic/Center
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
261QM0850X
Adult Mental Health Clinic/Center

Other

Enumeration date
12/23/2013
Last updated
04/01/2020
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