Provider Demographics
NPI:1457611014
Name:SANTA ROSA HEALTH ASSOCIATES, INC.
Entity type:Organization
Organization Name:SANTA ROSA HEALTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:SIFUENTES
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:323-216-2068
Mailing Address - Street 1:5011 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3116
Mailing Address - Country:US
Mailing Address - Phone:323-981-2933
Mailing Address - Fax:323-981-2935
Practice Address - Street 1:5011 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3116
Practice Address - Country:US
Practice Address - Phone:323-981-2933
Practice Address - Fax:323-981-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41270261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19011OtherCA PHYSICIAN ASSISTANT LICENSE
CA7205OtherCA FAMILY NURSE PRACTITIONER LICENSE
CA15206OtherCA FAMILY NURSE PRACTITIONER LICENSE
CAA41270OtherCA MEDICAL LICENSE