Healthcare Provider Details

I. General information

NPI: 1972620102
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 CAMINO ENTRADA
SANTA FE NM
87507-4876
US

IV. Provider business mailing address

2590 CAMINO ENTRADA
SANTA FE NM
87507-4876
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-3233
  • Fax: 505-946-3234
Mailing address:
  • Phone: 505-946-3233
  • Fax: 505-946-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: J ALEX VALDEZ
Title or Position: CEO PRESIDENT
Credential:
Phone: 505-820-5227