Healthcare Provider Details

I. General information

NPI: 1649835414
Provider Name (Legal Business Name): SANTA ROSA AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WIMBLEDON ESTATES DR
SPRING TX
77379-7322
US

IV. Provider business mailing address

7007 WIMBLEDON ESTATES DR
SPRING TX
77379-7322
US

V. Phone/Fax

Practice location:
  • Phone: 281-306-0000
  • Fax: 281-306-0000
Mailing address:
  • Phone: 281-306-0000
  • Fax: 281-306-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ZIGAL
Title or Position: CEO
Credential:
Phone: 281-306-0000