NPIMap

Organization Active NPI

Santa Rosa Community Healt Centers

Doing business as Santa Rosa Community Dental Center

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
National Provider Identifier
1023439759
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SANTA ROSA COMMUNITY HEALT CENTERS
Doing business as
Santa Rosa Community Dental Center
Practice address
1110 N Dutton Ave
Santa Rosa, CA 95401-4606
Phone
(707) 303-3600
Fax
(707) 396-5155
NPI assigned
Dec 24, 2013
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gabriela Bernal-Leroi, CEO
Title
Chief Executive Officer
Phone
(707) 303-3600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1110 N Dutton Ave
Santa Rosa, CA 95401-4606

Mailing address

3569 Round Barn Cir
Santa Rosa, CA 95403-5781
Phone (707) 303-3600

Other names 1

  • Santa Rosa Community Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

1110 N Dutton Ave
Santa Rosa, CA 95401
Phone (707) 303-3395

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1023439759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3569 ROUND BARN CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035781",
            "telephone_number": "707-303-3600",
            "fax_number": "707-396-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014606",
            "telephone_number": "707-303-3600",
            "fax_number": "707-396-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA COMMUNITY HEALT CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-24",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "BERNAL-LEROI",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-303-3600",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Rosa Community Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.