Organization
LA CLINICA DE LA RAZA INC
Active
Other names
Tiger Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-4000
Entity
Organization
Contact information
Practice address
4610 FOOTHILL BLVD, OAKLAND, CA 94601-4618
(510) 879-1600
(510) 879-8849
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
550000190
CA
261QS1000X
Student Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-1821
MEDICARE PART A
CA
05
—
FHC71137F
—
CA
01
—
HAP71137F
FPACT
CA
01
—
ZZZ2118Z
MEDICARE PART B
CA
Enumeration date
11/06/2006
Last updated
04/30/2024
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