NPIMap

Organization Active NPI

La Clinica de la Raza Inc

Doing business as La Clinica de La Raza

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
National Provider Identifier
1144336181
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
140000675 Issued in CA
Legal business name
LA CLINICA DE LA RAZA INC
Doing business as
La Clinica de La Raza
Practice address
3451 E 12TH St
Oakland, CA 94601-3425
Phone
(510) 535-4000
Fax
(510) 535-4189
NPI assigned
Aug 22, 2006
Last updated
Apr 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Authorized official

Name
Ms. Jane Garcia
Title
Chief Executive Officer
Phone
(510) 535-4000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 140000675 CA Primary
Radiology Clinic/Center 261QR0200X 036347 CA
Clinical Medical Laboratory 291U00000X CLIA0500601766 CA
Clinic Pharmacy 3336C0002X PHY46474 CA
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

3451 E 12TH St
Oakland, CA 94601-3425

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
FHC71021FMedicaidCA
LAB01766FMedicaidCA

Other names 1

  • La Clinica de La Raza 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
O20070214000424 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 1144336181. Details of each certification follow.

Federally qualified health center certification: CCN 551975

Legal name
LA CLINICA DE LA RAZA INC
Doing business as
LA CLINICA DE LA RAZA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 7, 2004
Last certification
Jul 7, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1971 in CA
Enrollment address
3451E 12TH St
Oakland, CA 94601-3425
Related CCNs
051821

Facilities connected through Provider of Services related, parent or unit certification numbers.

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

Locations

1501 Fruitvale Ave
Oakland, CA 94601

2021 Main St
Oakley, CA 94561
Phone (925) 776-8200

Ownership & related parties

All disclosed owners & managing parties 17

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 Feb 8, 2007
Yvonne Hudson-Harmon Individual Corporate Director Feb 8, 2007
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
Daniel I Ayala Individual Corporate DirectorBoard Member Dec 17, 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 Feb 8, 2007
Jane Garcia Individual Corporate OfficerChief Executive Officer Feb 8, 2007
W-2 Managing Employee Feb 8, 2007
Ramon J Terrazas Individual Corporate Director Feb 8, 2007
Rodney Leggett Individual Corporate DirectorBoard Member Sep 17, 2012
Robert Katter Individual Corporate Director Feb 8, 2007
Jorge Perez Individual Corporate DirectorBoard Member Apr 19, 2010
Norma Guerrero Individual Corporate Director Feb 8, 2007
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 285

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 285

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1144336181",
    "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": "3451 E 12TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946013425",
            "telephone_number": "510-535-4000",
            "fax_number": "510-535-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE LA RAZA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "510-535-4000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "140000675",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": "036347",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLIA0500601766",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "CA",
            "license": "PHY46474",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71021F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB01766F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica de La Raza",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Clinica de La Raza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.