| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 384 14th St, Oakland, California |
| Authorized Official Name and Position | David William Modersbach (GRANTS MGR AO) |
| Authorized Official Contact | 5108918916 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1404 Franklin St Ste 200 Oakland CA 94612-3208 Ph: (510) 891-8950 | 384 14th St Oakland CA 94612-3211 Ph: (510) 891-8950 |
| NPI Number | 1881632867 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 05/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881632867 | NPI | - | NPPES |
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