Provider Demographics
NPI:1275073959
Name:LA CLINICA DE LA RAZA
Entity Type:Organization
Organization Name:LA CLINICA DE LA RAZA
Other - Org Name:CASA DEL SOL
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORAL CLINICIAN 1
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHELA
Authorized Official - Middle Name:SHANTI
Authorized Official - Last Name:RICHHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MFTI
Authorized Official - Phone:510-535-6200
Mailing Address - Street 1:1501 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2322
Mailing Address - Country:US
Mailing Address - Phone:510-535-6200
Mailing Address - Fax:510-535-4167
Practice Address - Street 1:1501 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2322
Practice Address - Country:US
Practice Address - Phone:510-535-6200
Practice Address - Fax:510-535-4167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA CLINICA DE LA RAZA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health