Healthcare Provider Details

I. General information

NPI: 1063367803
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HOSPITAL DR
SANTA FE NM
87505-4754
US

IV. Provider business mailing address

1620 HOSPITAL DR
SANTA FE NM
87505-4754
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-4901
  • Fax: 505-913-6426
Mailing address:
  • Phone: 505-913-4901
  • Fax: 505-913-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLA L GOMEZ
Title or Position: PAYER ENROLLMENT COORDINATOR
Credential:
Phone: 505-913-5227