Organization
LA CLINICA DE LA RAZA, INC.
Active
Organization
LA CLINICA DE LA RAZA, INC.
Active
Other names
Roosevelt Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 535-4000
Entity
Organization
Contact information
Practice address
1926 - 19TH AVENUE, OAKLAND, CA 94606-4126
(510) 879-2953
(510) 879-2956
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
550000036
CA
261QS1000X
Student Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851522015
FPACT
CA
05
—
1851522015
—
CA
Enumeration date
08/05/2009
Last updated
10/17/2019
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