Organization
LA CLINICA DE LA RAZA INC
Active
Other names
La Clinica Dental at Children's Hospital Oakland
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-4000
Entity
Organization
Contact information
Practice address
4881 TELEGRAPH AVE, OAKLAND, CA 94609-2009
(510) 428-3316
(510) 450-5806
Mailing address
PO BOX 22210, OAKLAND, CA 94623-2210
(510) 535-4000
(510) 535-4189
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
140000670
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC71017F
—
CA
Enumeration date
07/23/2006
Last updated
02/06/2019
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