Healthcare Provider Details

I. General information

NPI: 1619234119
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST SUITE E
SANTA FE NM
87505-4780
US

IV. Provider business mailing address

1691 GALISTEO ST SUITE E
SANTA FE NM
87505-4780
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-2233
  • Fax: 505-983-2290
Mailing address:
  • Phone: 505-983-2233
  • Fax: 505-983-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number94-387
License Number StateNM

VIII. Authorized Official

Name: JOSEPH ALEX VALDEZ
Title or Position: CEO / PRESIDENT
Credential:
Phone: 505-913-5221