Healthcare Provider Details

I. General information

NPI: 1396922381
Provider Name (Legal Business Name): JONATHAN W HECHANOVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR CHRISTUS ST. VINCENT INTENSIVISTS
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

440 SAINT MICHAELS DR CSVMG PHYSICIAN PRACTICE
SANTA FE NM
87505-7602
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-2600
  • Fax: 505-983-7299
Mailing address:
  • Phone: 505-913-5227
  • Fax: 505-913-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD2013-0303
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: