| La Clinica Dental At Children's Hospital Oakland | |
|
4881 Telegraph Ave Oakland CA 94609-2009 | |
| (510) 428-3316 | |
| (510) 450-5806 |
| Full Name | La Clinica Dental At Children's Hospital Oakland |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 4881 Telegraph Ave, Oakland, California |
| Authorized Official Name and Position | Jane Garcia (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5105354000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Clinica Dental At Children's Hospital Oakland Po Box 22210 Oakland CA 94623-2210 Ph: (510) 535-4000 | La Clinica Dental At Children's Hospital Oakland 4881 Telegraph Ave Oakland CA 94609-2009 Ph: (510) 428-3316 |
| NPI Number | 1346262292 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 02/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346262292 | NPI | - | NPPES |
| FHC71017F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 140000670 (California) | Primary |
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