Provider Demographics
NPI:1225544638
Name:INSTITUTO FAMILIAR DE LA RAZA
Entity Type:Organization
Organization Name:INSTITUTO FAMILIAR DE LA RAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLERY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLACREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-229-0500
Mailing Address - Street 1:2919 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3917
Mailing Address - Country:US
Mailing Address - Phone:415-229-0500
Mailing Address - Fax:415-647-3662
Practice Address - Street 1:5128 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-229-0500
Practice Address - Fax:415-647-3662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTO FAMILIAR DE LA RAZA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-20
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IFR2919INOtherSAM -SYSTEM OF AWARD MANAGEMENT REGISTRATION