Provider Demographics
NPI:1801034061
Name:SANTA ROSA PRIMARY CARE INC
Entity Type:Organization
Organization Name:SANTA ROSA PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-757-4067
Mailing Address - Street 1:PO BOX 4091
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-4091
Mailing Address - Country:US
Mailing Address - Phone:830-757-4067
Mailing Address - Fax:830-776-5676
Practice Address - Street 1:819 CONCHO ST
Practice Address - Street 2:SUITE 5
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4074
Practice Address - Country:US
Practice Address - Phone:830-757-4067
Practice Address - Fax:830-776-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health