Organization
LA CLINICA DE LA RAZA INC
Active
Other names
La Clinica Monument
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-4000
Entity
Organization
Contact information
Practice address
2000 SIERRA ROAD, CONCORD, CA 94518-2905
(925) 363-2000
(925) 356-2792
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
140000675
CA
291U00000X
Clinical Medical Laboratory
05D1018270
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC71034F
—
CA
01
—
HAP71034F
FPACT
CA
Enumeration date
07/23/2006
Last updated
01/28/2013
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