Healthcare Provider Details

I. General information

NPI: 1942911045
Provider Name (Legal Business Name): JOSEPHINE GOLAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

330 GARFIELD ST STE 202
SANTA FE NM
87501-2677
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number032126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: