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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