| La Clinica Vallejo Dental | |
|
2920a Sonoma Blvd Vallejo CA 94590-3879 | |
| (707) 558-2000 | |
| (707) 644-3507 |
| Full Name | La Clinica Vallejo Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2920a Sonoma Blvd, Vallejo, 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 Vallejo Dental 1515 Fruitvale Ave Oakland CA 94601-2322 Ph: (510) 535-4000 | La Clinica Vallejo Dental 2920a Sonoma Blvd Vallejo CA 94590-3879 Ph: (707) 558-2000 |
| NPI Number | 1780606632 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780606632 | NPI | - | NPPES |
| FHC70833F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (California) | Primary |
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