NPIMap

Organization Active NPI

La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Vallejo, CA
National Provider Identifier
1992863096
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
550000257 Issued in CA
Legal business name
LA CLINICA DE LA RAZA INC
Practice address
210 Hospital Dr
Vallejo, CA 94589-2517
Phone
(707) 645-7316
Fax
(707) 645-0426
NPI assigned
Dec 4, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Jane Garcia
Title
Chief Executive Officer
Phone
(510) 535-2915

Other NPIs on the same Medicare enrollment 15

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

View all 15

Other NPIs with the same Medicare PAC ID 10

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

Practitioners 133

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 133

Medicare participation

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

Federally qualified health center certification: CCN 051070

Legal name
LA CLINICA DE LA RAZA INC
Doing business as
LA CLINICA VALLEJO GREAT BEGINNINGS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 2, 2007
Last certification
Feb 2, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1971 in CA
Enrollment address
210 Hospital Dr
Vallejo, CA 94589-2517

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
O20070124000298 CA Part a Provider - Federally Qualified Health Center (FQHC) 1557258282 Practice locations: Vallejo, CA

All disclosed owners & managing parties 16

Medicare enrollment files

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

NameRoleSinceShare
Yvonne Hudson-Harmon Individual Corporate Director Jan 18, 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 DirectorDirector 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 Jan 18, 2007
Jane Garcia Individual Corporate OfficerChief Executive Officer Jan 18, 2007
W-2 Managing Employee Jul 22, 2015
Ramon J Terrazas Individual Corporate Director Jan 18, 2007
Rodney Leggett Individual Corporate DirectorBoard Member Jul 17, 2012
Robert Katter Individual Corporate Director Jan 18, 2007
Jorge Perez Individual Corporate DirectorBoard Member Apr 19, 2010
Norma Guerrero Individual Corporate Director Jan 18, 2007
Andrew Cleophas Peterson Individual Corporate DirectorBoard Member Oct 1, 2013
Paul M Swenson Individual Corporate DirectorBoard Member Jul 9, 2008

National Provider Directory

National Provider Directory

Locations

220 Hospital Dr
Vallejo, CA 94589
Phone (707) 641-1900

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X 550000257 CA Primary
Clinical Medical Laboratory 291U00000X 05D1057049 CA

Addresses

NPPES NPI Registry

Primary practice location

210 Hospital Dr
Vallejo, CA 94589-2517

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
FHC71149FMedicaidCA

Other names 1

NPPES NPI Registry
  • La Clinica Vallejo Great Beginnings Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 17, 2019.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1992863096",
    "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": "210 HOSPITAL DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892517",
            "telephone_number": "707-645-7316",
            "fax_number": "707-645-0426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE LA RAZA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "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": "510-535-2915",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000257",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D1057049",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71149F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica Vallejo Great Beginnings",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Clinica Vallejo Great Beginnings",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.