Healthcare Provider Details

I. General information

NPI: 1609105139
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 A W ZIA RD
SANTA FE NM
87505-6996
US

IV. Provider business mailing address

490 A W ZIA RD
SANTA FE NM
87505-6996
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-8900
  • Fax: 505-913-8923
Mailing address:
  • Phone: 505-913-8900
  • Fax: 505-913-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

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