NPIMap

Organization Active NPI

La Clinica de la Raza Inc

Doing business as Family Optical I

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
National Provider Identifier
1124035159
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
140000708 Issued in CA
Legal business name
LA CLINICA DE LA RAZA INC
Doing business as
Family Optical I
Practice address
3060B E 9TH St
Oakland, CA 94601-2322
Phone
(510) 535-5500
Fax
(510) 535-4349
NPI assigned
Aug 2, 2006
Last updated
Dec 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Patricia Aguilera
Title
Chief Executive Officer
Phone
(510) 535-2915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Federally Qualified Health Center (FQHC) 261QF0400X 140000708 CA Primary

Addresses

Primary practice location

3060B E 9TH St
Oakland, CA 94601-2322

Mailing address

PO Box 22210
Oakland, CA 94623-2210
Phone (510) 535-4000

Other names 1

  • Family Optical I Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040227001016 CA Part B Supplier - Clinic/Group Practice 1557258282 Receives reassigned benefits from 204 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vallejo, CA; Pittsburg, CA; Oakley, CA; Oakland, CA; Concord, CA
O20061110000417 CA Part A Provider - Federally Qualified Health Center (FQHC) 1557258282 Practice locations: Oakland, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124035159. Details of each certification follow.

Federally qualified health center certification: CCN 051066

Legal name
LA CLINICA DE LA RAZA INC
Doing business as
FAMILY OPTICAL I
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2006
Last certification
Nov 22, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1971 in CA
Enrollment address
3060 E 9TH St
Ste B
Oakland, CA 94601-2925

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Peter G Manoleas Individual Corporate Director Nov 3, 2006
Karen Chester Individual W-2 Managing Employee Nov 3, 2006
Yvonne Hudson-Harmon Individual Corporate Director Nov 3, 2006
Michael C Moore Individual Corporate DirectorBoard Member Nov 15, 2010
Aisha Hampton-Bowser Individual Corporate DirectorBoard Member Dec 8, 2007
Maria Caldera Individual Corporate DirectorBoard Member Oct 1, 2013
Luz S Lizardo Individual Corporate DirectorBoard Member Jul 1, 2013
Amy Prevedel Individual Corporate DirectorBoard Member Oct 19, 2009
Jill Noonan Individual Corporate Director Nov 3, 2006
Jane Garcia Individual Corporate OfficerChief Executive Officer Nov 3, 2006
Patricia Aguilera Individual Corporate OfficerChief Financial Officer Oct 1, 2013
Ramon J Terrazas Individual Corporate Director Nov 3, 2006
Rodney Leggett Individual Corporate DirectorBoard Member Sep 17, 2012
Ana Rosas Individual W-2 Managing Employee Nov 3, 2006
Robert Katter Individual Corporate Director Nov 3, 2006
Jorge Perez Individual Corporate DirectorBoard Member Apr 19, 2010
Norma Guerrero Individual Corporate DirectorBoard Member Jan 20, 2000
Andrew Cleophas Peterson Individual Corporate DirectorBoard Member Oct 1, 2013
Paul M Swenson Individual Corporate DirectorBoard Member Jul 9, 2008

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1124035159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22210",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946232210",
            "telephone_number": "510-535-4000",
            "fax_number": "510-535-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060B E 9TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012322",
            "telephone_number": "510-535-5500",
            "fax_number": "510-535-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE LA RAZA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2014-12-10",
        "status": "A",
        "authorized_official_last_name": "AGUILERA",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "510-535-2915",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "140000708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Optical I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.