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General NPI Number Information
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NPI Number | 1457611014
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Entity Type | Organization
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Legal Business Name | SANTA ROSA HEALTH ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 5011 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3116
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Country | US
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Telephone | 323-981-2933
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Fax | 323-981-2935
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Provider Business Mailing Address
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Address Line | 5011 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3116
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Country | US
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Telephone | 323-981-2933
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Fax | 323-981-2935
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Authorized Official
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Title or Position | CFO, OWNER
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Name | MRS. TERESA SIFUENTES ORTIZ
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Credential | FNP
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Telephone | 323-216-2068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A41270
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License Number State | CA
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