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General NPI Number Information
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NPI Number | 1881871341
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Entity Type | Organization
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Legal Business Name | SANTA ROSA FAMILY CARE CENTER
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 1234 E FLORENCE AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90001-2433
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Country | US
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Telephone | 323-583-6814
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Fax | 323-583-6818
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Provider Business Mailing Address
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Address Line | 1234 E FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90001-2433
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Country | US
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Telephone | 323-583-6814
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Fax | 323-583-6818
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TERESA S ORTIZ
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Credential | FNP
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Telephone | 323-583-6814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | CA
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