Healthcare Provider Details

I. General information

NPI: 1093042632
Provider Name (Legal Business Name): SANTA FE FOOT AND ANKLE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 06/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST UNIT A4
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST UNIT A4
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-3338
  • Fax: 505-982-3668
Mailing address:
  • Phone: 505-988-3338
  • Fax: 505-982-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: GLENDA L KING
Title or Position: MEMBER/OWNER
Credential: DPM
Phone: 505-988-3338