Healthcare Provider Details

I. General information

NPI: 1083457618
Provider Name (Legal Business Name): ROSEMARY VIGIL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11104 VISTAZO PL SE
ALBUQUERQUE NM
87123-5990
US

IV. Provider business mailing address

11104 VISTAZO PL SE
ALBUQUERQUE NM
87123-5990
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-7302
  • Fax:
Mailing address:
  • Phone: 505-220-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8954
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: