Healthcare Provider Details

I. General information

NPI: 1750208682
Provider Name (Legal Business Name): SANTA FE DERM AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST STE C1
SANTA FE NM
87505-2158
US

IV. Provider business mailing address

2074 GALISTEO ST STE C1
SANTA FE NM
87505-2158
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-3828
  • Fax: 505-629-4241
Mailing address:
  • Phone: 505-470-3828
  • Fax: 505-629-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GONZALEZ
Title or Position: OWNER
Credential: APRN-CNP
Phone: 505-470-3828