Healthcare Provider Details

I. General information

NPI: 1679572804
Provider Name (Legal Business Name): SANTA ROSA FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/21/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 CHRISTUS HLS 3RD FLOOR
SAN ANTONIO TX
78251-3585
US

IV. Provider business mailing address

11130 CHRISTUS HLS MEDICAL PLAZA 3, 3RD FL
SAN ANTONIO TX
78251-3585
US

V. Phone/Fax

Practice location:
  • Phone: 210-703-9001
  • Fax: 210-703-9155
Mailing address:
  • Phone: 210-703-9001
  • Fax: 210-703-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. CHRISTINE D CRISCUOLOHIGGINS
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 210-703-9045