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NPI Code Detail

MEDICARE: SANTA ROSA COMMUNITY HEALTH CENTERS

MEDICARE: SANTA ROSA COMMUNITY HEALTH CENTERS
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
1261QF0400XFederally Qualified Health Center (FQHC)110000300CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386712065
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA ROSA COMMUNITY HEALTH CENTERS
Provider Business Mailing Address
First Line : 3569 ROUND BARN CIRCLE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-5781
Country : US
Telephone Number : 707-303-3600
Fax Number : 707-303-3635
Provider Business Practice Location Address
First Line : 751 LOMBARDI COURT
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-6798
Country : US
Telephone Number : 707-547-2222
Fax Number : 707-527-0472
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : GABRIELA BERNAL-LEROI
Credential : CEO
Telephone Number : 707-303-3600
Provider Enumeration Date : 12/01/2006
Last Update Date : 12/09/2022

Similar Medicare Providers

1457928012 — ALEXIS VICTORIA CHAET-LOPEZ MD
Practice Location Address:
751 LOMBARDI CT
SANTA ROSA, CA
95407-6798
Practice Phone: 707-303-3600
Practice Fax:
1164628590 — JOSEPH IVAN EICHENSEHER MD
Practice Location Address:
751 LOMBARDI CT
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1831163716 — TARA JEANINE BUDINGER PH D
Practice Location Address:
751 LOMBARDI CT
SANTA ROSA, CA
95407-6798
Practice Phone: 707-547-2222
Practice Fax:
1942225156 — KAMEREN JOY OWENS ANP
Practice Location Address:
751 LOMBARDI CT
SANTA ROSA, CA
95407-6798
Practice Phone: 707-303-3600
Practice Fax:
1255414009 — SUELLEN S ESCHENBACH RN, NP
Practice Location Address:
751 LOMBARDI CT
SANTA ROSA, CA
95407-6798
Practice Phone: 707-547-2222
Practice Fax: 707-547-2229
1710013289 — MS. ALICE MARIE HARRIS FNP
Practice Location Address:
751 LOMBARDI CT
SANTA ROSA, CA
95407-6798
Practice Phone: 707-547-2222
Practice Fax: 707-547-2229

Directions to “SANTA ROSA COMMUNITY HEALTH CENTERS ” Practice Location

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