Organization
LA CLINICA DE LA RAZA, INC.
Active
Other names
La Clinica North Vallejo
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-2915
Entity
Organization
Contact information
Practice address
220 HOSPITAL DR, VALLEJO, CA 94589-2517
(707) 641-1900
(707) 554-2294
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
110000270
CA
291U00000X
Clinical Medical Laboratory
05D1087668
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720243454
—
CA
Enumeration date
07/22/2008
Last updated
10/17/2019
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