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General NPI Number Information
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NPI Number | 1083026140
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Entity Type | Individual
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Provider Name | MR. DAMEK SANTIAGO MAURICE
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Gender | Male
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | CHRISTUS ST. VINCENT REGIONAL MEDICAL CENTER 455 ST. MICHAELS DRIVE
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-913-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 OLD PECOS TRL STE H
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City | SANTA FE
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State | NM
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Zip | 87505-4777
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Country | US
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Telephone | 505-992-0233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A225519
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 63756
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License Number State | NY
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