Healthcare Provider Details

I. General information

NPI: 1710254883
Provider Name (Legal Business Name): KARLA JEANNETTE RAMIREZ-VIGIL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH 48 MDG/SGHC UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

101 BODEN CIRCLE
TRAVIS AFB CA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8603
  • Fax:
Mailing address:
  • Phone: 707-423-5174
  • Fax: 707-423-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3930
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: