Organization
LA CLINICA DE LA RAZA INC
Active
Other names
Clinica Alta Vista
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-4000
Entity
Organization
Contact information
Practice address
1515 FRUITVALE AVE, OAKLAND, CA 94601-2322
(510) 535-6300
(510) 535-4019
Mailing address
PO BOX 22210, OAKLAND, CA 94623-2210
(510) 535-4000
(510) 535-4189
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550000036
CA
291U00000X
Clinical Medical Laboratory
CLIA0500921212
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC71087F
—
CA
Enumeration date
08/22/2006
Last updated
10/17/2019
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