Healthcare Provider Details

I. General information

NPI: 1679938112
Provider Name (Legal Business Name): VIGILANT FAMILY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PLEASANT ST
BROCKTON MA
02301-3236
US

IV. Provider business mailing address

38 CURTIS ST
BROCKTON MA
02301-6376
US

V. Phone/Fax

Practice location:
  • Phone: 857-991-8438
  • Fax:
Mailing address:
  • Phone: 857-991-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GUELDINE VALME
Title or Position: PRESIDENT
Credential: NP
Phone: 857-991-8438