Healthcare Provider Details

I. General information

NPI: 1457618852
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR SUITE B-104
SANTA FE NM
87505-7672
US

IV. Provider business mailing address

435 SAINT MICHAELS DR SUITE B-104
SANTA FE NM
87505-7672
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ALEX VALDEZ
Title or Position: CEO/PRESIDENT
Credential:
Phone: 505-913-5201