Healthcare Provider Details

I. General information

NPI: 1568589653
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SOUTH GALISTEO ST
SANTA FE NM
87505-2101
US

IV. Provider business mailing address

455 SAINT MICHAELS DR ATTN. CARLA GOMEZ, PHYSICIAN PRACTICES
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-4901
  • Fax: 505-989-6483
Mailing address:
  • Phone: 505-820-5227
  • Fax: 505-820-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. J ALEX VALDEZ
Title or Position: CEO
Credential:
Phone: 505-820-5202