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General NPI Number Information
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NPI Number | 1619234119
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Entity Type | Organization
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Legal Business Name | ST. VINCENT HOSPITAL
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 1691 GALISTEO ST SUITE E
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City | SANTA FE
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State | NM
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Zip | 87505-4780
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Country | US
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Telephone | 505-983-2233
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Fax | 505-983-2290
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Provider Business Mailing Address
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Address Line | 1691 GALISTEO ST SUITE E
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City | SANTA FE
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State | NM
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Zip | 87505-4780
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Country | US
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Telephone | 505-983-2233
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Fax | 505-983-2290
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | JOSEPH ALEX VALDEZ
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Credential |
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Telephone | 505-913-5221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 94-387
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License Number State | NM
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