Healthcare Provider Details

I. General information

NPI: 1982104709
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR STE 220
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

465 SAINT MICHAELS DR STE 220
SANTA FE NM
87505-8602
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3380
  • Fax: 505-913-3389
Mailing address:
  • Phone: 505-913-3380
  • Fax: 505-913-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LILLIAN MONTOYA
Title or Position: CEO
Credential:
Phone: 505-913-5201