LA CLINICA DE LA RAZA, INC. (NPI# 1578834164) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578834164 |
| Entity Type | Organization |
| Organization Name | LA CLINICA DE LA RAZA, INC. |
| Other Organization Name | LA CLINICA OAKLEY |
| Practice Address |
2021 Main St Oakley CA 94561-3302 |
| Mailing Address |
Po Box 22210 Oakland CA 94623-2210 |
| Practice Telephone | 9257768200 |
| Practice Fax Number | 9257768260 |
| Mailing Telephone | 5105354000 |
| Mailing Fax Number | 5105354189 |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2019-10-17 |
| Authorized Official Name | MS. JANE GARCIA (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 5105354000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 291U00000X | Clinical Medical Laboratory | CLIA05D2036282 | Laboratories | |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
550002122 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1578834164 | 05 |
| Other Name | Type Code |
|---|---|
| La Clinica Oakley | 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 |
| 1730476110 | La Clinica De La Raza, Inc. | Pharmacy | 1030 International Blvd, Oakland, CA 94606-3730 | 2011-07-06 |
| 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 |
2021 MAIN ST |
| City | OAKLEY |
| State | CA |
| Zip Code | 94561-3302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255562443 | Siomara De Anda Mar | Marriage & Family Therapist | 2021 Main St, Oakley, CA 94561-3302 | 2009-08-05 |
| 1043766678 | Kalynn Yastro | Registered Nurse | 2021 Main St, Oakley, CA 94561-3302 | 2016-09-01 |
| 1760935753 | Keith Bonnes | Student in an Organized Health Care Education/Training Program | 2021 Main St, Oakley, CA 94561-3302 | 2016-07-26 |
| 1033589486 | Josephine Mumbi Githua | Family Medicine | 2021 Main St, Oakley, CA 94561-3302 | 2015-09-29 |
| 1518334465 | Mariya Ryazantseva | Nurse Practitioner | 2021 Main St, Oakley, CA 94561-3302 | 2015-08-26 |
| 1003249244 | Shuinn Chang | Registered Nurse | 2021 Main St, Oakley, CA 94561-3302 | 2013-08-12 |
| 1174962054 | Sarah Elizabeth Broome | Physician Assistant | 2021 Main St, Oakley, CA 94561-3302 | 2013-06-24 |
| 1184063554 | Natalie Calida Vizcarra | Physician Assistant | 2021 Main St, Oakley, CA 94561-3302 | 2013-06-19 |
| 1356614762 | Christina Loeliger | Nurse Practitioner | 2021 Main St, Oakley, CA 94561-3302 | 2012-02-15 |
| 1992036172 | Jose Luis Trujillo | Counselor | 2021 Main St, Oakley, CA 94561-3302 | 2010-01-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720565609 | Andrehina Salinas | Psychologist | 501 Norcross Ln, Oakley, CA 94561 | 2018-07-24 |
| 1629375514 | Prevailing Winds International | Community/Behavioral Health | 6327 Bethel Island, Ste A 1011, Bethel Island, CA 94561 | 2011-02-11 |
| 1851698781 | Elizabeth Phillips | Social Worker | 1506 Yosemite Circle, Oakley, CA 94561 | 2011-02-11 |
| 1093831539 | Richard John Dare | Dentist | 2571 Main St, Oakley, CA 94561 | 2007-03-22 |
| 1447380357 | New Way Services Inc | Intermediate Care Facility, Mentally Retarded | 92 Lozoya Way, Oakley, CA 94561 | 2007-03-07 |
| 1184779779 | New Way Services Inc | Intermediate Care Facility, Mentally Retarded | 385 Hill Ave, Oakley, CA 94561 | 2007-01-24 |
| 1821151846 | New Way Services Inc | Intermediate Care Facility, Mentally Retarded | 1325 Yosemite Circle, Oakley, CA 94561 | 2006-12-19 |
| 1467515064 | New Way Services Inc | Intermediate Care Facility, Mentally Retarded | 606 Glacier Way, Oakley, CA 94561 | 2006-12-18 |
| 1205912169 | Rick D Junnila | Chiropractor | 5351 Neroly Rd., Ste. B, Oakley, CA 94561 | 2006-10-31 |
| 1699795237 | Lourdes De La Cruz | Pediatrics | 3090 Frandoras Circle, Oakley, CA 94561 | 2006-07-19 |
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| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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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.