Healthcare Provider Details

I. General information

NPI: 1588773816
Provider Name (Legal Business Name): VALDA L VIGIL-ST ARNOLD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DRIVE NE PMG URGENT CARE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8519
  • Fax: 505-823-8355
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number94-PA04
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: