Provider Demographics
NPI:1487087094
Name:SANTA MARIA MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:SANTA MARIA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CANELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-389-5935
Mailing Address - Street 1:PO BOX 23067
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-0067
Mailing Address - Country:US
Mailing Address - Phone:210-389-5935
Mailing Address - Fax:
Practice Address - Street 1:1003 FAIR AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1327
Practice Address - Country:US
Practice Address - Phone:210-389-5935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty