Basic Information
| Provider Information | |||||||||
| NPI: | 1194185470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LA CLINICA DE LA RAZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22210 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946232210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105353900 | ||||||||
| FaxNumber: | 5105354128 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 SIERRA RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945182905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253632000 | ||||||||
| FaxNumber: | 9253632006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2016 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | JULES | ||||||||
| AuthorizedOfficialFirstName: | ALFA | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5105352965 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95003462 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.