LA CLINICA DE LA RAZA, INC. (NPI# 1720243454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1720243454 |
Entity Type | Organization |
Organization Name | LA CLINICA DE LA RAZA, INC. |
Other Organization Name | LA CLINICA NORTH VALLEJO |
Practice Address |
220 Hospital Dr Vallejo CA 94589-2517 |
Mailing Address |
Po Box 22210 Oakland CA 94623-2210 |
Practice Telephone | 7076411900 |
Practice Fax Number | 7075542294 |
Mailing Telephone | 5105354000 |
Mailing Fax Number | 5105354189 |
Enumeration Date | 2008-07-22 |
Last Update Date | 2019-10-17 |
Authorized Official Name | MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER) |
Authorized Official Telephone | 5105352915 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 291U00000X | Clinical Medical Laboratory | 05D1087668 | CA | Laboratories |
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
110000270 | CA | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | 1720243454 | 05 |
Other Name | Type Code |
---|---|
La Clinica North Vallejo | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982118675 | La Clinica De La Raza, Inc. | Clinic/Center | 2005c Main St, Oakley, CA 94561-3301 | 2017-11-17 |
1669773008 | La Clinica De La Raza, Inc. | Clinic/Center | 3709 E 12th St, Oakland, CA 94601-4001 | 2010-11-16 |
1629379896 | La Clinica De La Raza, Inc. | Clinic/Center | 1415-1423 Fruitvale Ave, Oakland, CA 94601-2320 | 2010-11-04 |
1851522015 | La Clinica De La Raza, Inc. | Clinic/Center | 1926 - 19th Avenue, Oakland, CA 94606-4126 | 2009-08-05 |
1184194482 | La Clinica De La Raza, Inc. | Pharmacy | 3451 E 12th St, Oakland, CA 94601-3463 | 2018-11-29 |
1477961613 | La Clinica De La Raza, Inc. | Clinic/Center | 4610 Foothill Blvd, Oakland, CA 94601-4618 | 2014-07-31 |
1770902314 | La Clinica De La Raza, Inc. | Clinic/Center | 1450 Fruitvale Ave, 3rd Floor, Oakland, CA 94601-2313 | 2014-04-10 |
1023445780 | La Clinica De La Raza, Inc. | Clinic/Center | 1700 28th Ave, Oakland, CA 94601-2455 | 2013-09-26 |
1245671726 | La Clinica De La Raza, Inc. | Clinic/Center | 1390 66th Ave, Oakland, CA 94621-3506 | 2013-07-11 |
1578834164 | La Clinica De La Raza, Inc. | Clinical Medical Laboratory | 2021 Main St, Oakley, CA 94561-3302 | 2012-01-13 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | LA CLINICA DE LA RAZA, INC. | 1515 Fruitvale Ave, Oakland, CA 94601-2322 |
Street Address |
220 HOSPITAL DR |
City | VALLEJO |
State | CA |
Zip Code | 94589-2517 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427612910 | Heather Wright | Physician Assistant | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2019-04-30 |
1235515511 | La Clinica De La Raza | Clinic/Center | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2015-08-10 |
1598083164 | Hakeem O. Adeniyi Jr. | Family Medicine | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2010-05-06 |
1962737460 | Marites Less | Nurse Practitioner | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2009-10-16 |
1245462209 | Sarah Catherine Quesnell | Social Worker | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2009-08-10 |
1538241401 | Aide Irene Paredes-salceda | Physician Assistant | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2006-10-20 |
1811098007 | Ruth Etta Shelton-pryor | Family Medicine | 220 Hospital Dr, Vallejo, CA 94589-2517 | 2006-09-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366903478 | Nabreea Dianna Moore | Behavioral Analyst | 1300 Donner Pass Rd, Vallejo, CA 94589 | 2019-03-29 |
1588131221 | Alejandra Hernandez De Leon | Behavioral Analyst | 151 Mimosa Ct, Vallejo, CA 94589 | 2018-10-31 |
1821588948 | Angela Ancheta Laco | Behavioral Analyst | 71 Los Cerritos Dr, Vallejo, CA 94589 | 2018-05-14 |
1851750764 | Shauntell Hudson | Counselor | 112 Basalt Dr, Vallejo, CA 94589 | 2016-02-19 |
1982997680 | Shuttle California Transit, LLC | Private Vehicle | 322 Lemon St, Vallejo, CA 94589 | 2011-05-27 |
1588813455 | Shay Teresa Loftus | Psychologist | 1761 Broadway, Suite 100, Vallejo, CA 94589 | 2008-09-16 |
1063629236 | Michael Francis Edziak | Dentist | 150 Hospital Dr., Vallejo, CA 94589 | 2007-05-17 |
1346454220 | Diljit Bahuleyan Karayil | Internal Medicine | 975 Sereno Drive, Medical Office- 8, Kaiser Permanente Medical Center, Vallejo, CA 94589 | 2007-05-09 |
1174745525 | Thomas Welch Gross | Emergency Medicine | Emergency Dept., Kaiser Permanente Medical Center, 675 Sereno Dr, Vallejo, CA 94589 | 2007-05-03 |
1639207756 | James D Prigmore | Dentist | 1620 Valle Vista Ave, Ste 100, Vallejo, CA 94589 | 2007-03-01 |
Find all providers in zip 94589 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962739946 | La Clinica De La Raza, Inc. | Clinic/Center | 220 Hospital Drive, Vallejo, CA 94589-2517 | 2009-11-11 |
1598986010 | County of Solano | Clinic/Center | 355 Tuolumne St, Vallejo, CA 94590-5700 | 2007-05-01 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.