Organization
LA CLINICA DE LA RAZA INC
Active
Organization
LA CLINICA DE LA RAZA INC
Active
Other names
La Clinica de La Raza--Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-4000
Entity
Organization
Contact information
Practice address
3050 E 16TH ST, OAKLAND, CA 94601-2319
(510) 535-4000
(510) 535-4189
Mailing address
1601 FRUITVALE AVE, OAKLAND, CA 94601-2322
(510) 535-4000
(510) 535-4189
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC12017F
—
CA
Enumeration date
08/22/2006
Last updated
10/26/2007
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