Organization
LA CLINICA DE LA RAZA INC
Active
Other names
La Clinica Vallejo
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER)
(510) 354-4000
Entity
Organization
Contact information
Practice address
243 GEORGIA ST, SUITE B, VALLEJO, CA 94590-5905
(707) 556-8100
(707) 556-8107
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
05D0880562
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70543G
—
CA
Enumeration date
08/21/2006
Last updated
10/17/2019
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