Healthcare Provider Details

I. General information

NPI: 1023967601
Provider Name (Legal Business Name): GEORGETTE VIGIL CPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 TRUMAN ST NE
ALBUQUERQUE NM
87110-1961
US

IV. Provider business mailing address

3119 TRUMAN ST NE
ALBUQUERQUE NM
87110-1961
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-9553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: