Provider Demographics
NPI:1194185470
Name:LA CLINICA DE LA RAZA
Entity Type:Organization
Organization Name:LA CLINICA DE LA RAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALFA
Authorized Official - Middle Name:
Authorized Official - Last Name:JULES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-535-2965
Mailing Address - Street 1:PO BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-3900
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:2000 SIERRA RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2905
Practice Address - Country:US
Practice Address - Phone:925-363-2000
Practice Address - Fax:925-363-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty