La Clinica De La Raza INC
Clinic/Center, Federally Qualified Health Center (FQHC) in Vallejo, CA. Organization (NPI-2).
NPI number1992811392
StatusActive
Last updated in NPPESOct 17, 2019
Details
- NPI
- 1992811392
- Entity type
- Organization (NPI-2)
- Legal business name
- La Clinica De La Raza INC
- Organization subpart
- No
- Enumeration date
- Aug 21, 2006
- Last updated
- Oct 17, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | 110000270 | CA | Yes |
| 291U00000X | Clinical Medical Laboratory | 05D0880562 | CA |
Other names
- La Clinica Vallejo (Doing Business As)
Practice location
243 Georgia StSuite B
Vallejo, CA 94590-5905
Phone 707-556-8100 · Fax 707-556-8107
Mailing address
Po Box 22210Oakland, CA 94623-2210
Phone 510-535-4000 · Fax 510-535-4189
Authorized official
Jane Garcia
Chief Executive Officer
5103544000
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All 6 Federally Qualified Health Center (FQHC) providers in Vallejo · All 3,369 providers in Vallejo
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