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NPI Code Detail

MEDICARE: SANTA ROSA FAMILY HEALTH CENTER

MEDICARE: SANTA ROSA FAMILY HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10803595-02OTHERTXCIDC GROUP NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30803595-03OTHERTXEPSDT FACILITY NUMBER

General Provider Information

NPI Number : 1679572804
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA ROSA FAMILY HEALTH CENTER
Provider Business Mailing Address
First Line : 11130 CHRISTUS HLS
Second Line : MEDICAL PLAZA 3, 3RD FL
City : SAN ANTONIO
State : TX
Zip : 78251-3585
Country : US
Telephone Number : 210-703-9001
Fax Number : 210-703-9155
Provider Business Practice Location Address
First Line : 11130 CHRISTUS HLS
Second Line : 3RD FLOOR
City : SAN ANTONIO
State : TX
Zip : 78251-3585
Country : US
Telephone Number : 210-703-9001
Fax Number : 210-703-9155
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : DR. CHRISTINE D CRISCUOLOHIGGINS
Credential : MD
Telephone Number : 210-703-9045
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/21/2022

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1811554108 — SERENA LAWRENCE CUELLAR MD
Practice Location Address:
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Directions to “SANTA ROSA FAMILY HEALTH CENTER ” Practice Location

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