Provider Demographics
NPI:1033267497
Name:INSTITUTO FAMILIAR DE LA RAZA
Entity type:Organization
Organization Name:INSTITUTO FAMILIAR DE LA RAZA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ARCINIEGA
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:415-229-0500
Mailing Address - Street 1:2919 MISSION STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-229-0500
Mailing Address - Fax:415-647-3662
Practice Address - Street 1:2919 MISSION STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-229-0500
Practice Address - Fax:415-647-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFV015AOtherPTAN