NPIMap

Organization Active NPI

La Clinica de la Raza Inc

Doing business as La Clinica Pittsburg - Medical

  • Federally Qualified Health Center (FQHC)
  • Pittsburg, CA
National Provider Identifier
1972525822
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
140000584 Issued in CA
Legal business name
LA CLINICA DE LA RAZA INC
Doing business as
La Clinica Pittsburg - Medical
Practice address
2240 Gladstone Dr
Suite 4
Pittsburg, CA 94565-5126
Phone
(925) 431-1259
Fax
(925) 431-1257
NPI assigned
Jul 23, 2006
Last updated
Oct 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 140000584 CA Primary
Clinical Medical Laboratory 291U00000X 05D0954154 CA

Addresses

Primary practice location

2240 Gladstone Dr
Suite 4
Pittsburg, CA 94565-5126

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
FHC70816FMedicaidCA

Other names 1

  • La Clinica Pittsburg - Medical 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
O20040701000132 CA Part A Provider - Federally Qualified Health Center (FQHC) 1557258282 Practice locations: Pittsburg, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972525822. Details of each certification follow.

Federally qualified health center certification: CCN 551976

Legal name
LA CLINICA DE LA RAZA INC
Doing business as
LA CLINICA PITTSBURG - MEDICAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 20, 2004
Last certification
Jul 20, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1971 in CA
Enrollment address
2240 Gladstone Dr
4
Pittsburg, CA 94565-5126
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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0954154La Clinica Pittsburg-Medical2240 Gladstone Dr Ste 4, Pittsburg, CA 94565Provider-performed microscopyNov 17, 2026

National Provider Directory

National Provider Directory

Locations

2240 Gladstone Dr
Ste 4
Pittsburg, CA 94565
Phone (925) 431-1230

Ownership & related parties

All disclosed owners & managing parties 15

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 Jul 8, 2004
Yvonne Hudson-Harmon Individual Corporate Director Jul 8, 2004
Michael C Moore Individual Corporate DirectorBoard Member Nov 15, 2010
Aisha Hampton-Bowser Individual Corporate DirectorBoard Member Dec 8, 2007
Daniel I Ayala Individual Corporate DirectorBoard Member Dec 17, 2013
Leticia Cazares Individual W-2 Managing Employee May 17, 2007
Jill Noonan Individual Corporate Director Jul 8, 2004
Jane Garcia Individual Corporate OfficerChief Executive Officer May 17, 2007
W-2 Managing Employee Aug 21, 1980
Viola Lujan Individual W-2 Managing Employee Jun 24, 1984
Ramon J Terrazas Individual Corporate Director Jul 8, 2004
Rodney Leggett Individual Corporate DirectorBoard Member Sep 17, 2012
Robert Katter Individual Corporate Director May 17, 2007
Jorge Perez Individual Corporate DirectorBoard Member Apr 19, 2010
Norma Guerrero Individual Corporate Director May 17, 2007
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 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1972525822",
    "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": "2240 GLADSTONE DR",
            "address_2": "SUITE 4",
            "city": "PITTSBURG",
            "state": "CA",
            "postal_code": "945655126",
            "telephone_number": "925-431-1259",
            "fax_number": "925-431-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE LA RAZA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2019-10-17",
        "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": "140000584",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D0954154",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70816F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica Pittsburg - Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Clinica Pittsburg - Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsburg, CA

Sources for this page

Verify at the official NPI Registry.