Healthcare Provider Details

I. General information

NPI: 1346476173
Provider Name (Legal Business Name): SANTA FE CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 117
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

465 SAINT MICHAELS DR SUITE 117
SANTA FE NM
87505-7670
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-2600
  • Fax: 505-878-1441
Mailing address:
  • Phone: 505-992-2600
  • Fax: 505-878-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2006-0177
License Number StateNM

VIII. Authorized Official

Name: DR. MARCELLIN SIMARD
Title or Position: OWNER
Credential: M.D.
Phone: 505-992-2600