Basic Information
| Provider Information | |||||||||
| NPI: | 1740798206 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN ALAMEDA COUNTY COMITE FOR RAZA MENTAL HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LA FAMILIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24301 SOUTHLAND DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945451546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103003516 | ||||||||
| FaxNumber: | 5102919591 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 FAIRMONT DR | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108815921 | ||||||||
| FaxNumber: | 5108815921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | SALVATIER | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS & BILLING | ||||||||
| AuthorizedOfficialTelephone: | 5103003170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.