Provider Demographics
NPI:1669642914
Name:NATIVE AMERICAN HEALTH CENTER, INC
Entity Type:Organization
Organization Name:NATIVE AMERICAN HEALTH CENTER, INC
Other - Org Name:NATIVE AMERICAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING & LICENSING ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCUS-FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-485-5906
Mailing Address - Street 1:3124 INTERNATIONAL BLVD
Mailing Address - Street 2:ROOM 314
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2228
Mailing Address - Country:US
Mailing Address - Phone:510-485-5906
Mailing Address - Fax:510-485-5919
Practice Address - Street 1:160 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:510-485-5906
Practice Address - Fax:510-485-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
CA220000207261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551875Medicare Oscar/Certification
CA551875Medicare PIN