Healthcare Provider Details

I. General information

NPI: 1891846259
Provider Name (Legal Business Name): VIVIAN A. FERNANDEZ GEILIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ENCINO PL NE
ALBUQUERQUE NM
87102-2602
US

IV. Provider business mailing address

416 EL DORADO DR NW
ALBUQUERQUE NM
87114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-0833
  • Fax:
Mailing address:
  • Phone: 505-321-0833
  • Fax: 505-244-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1290
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: