Healthcare Provider Details

I. General information

NPI: 1962936534
Provider Name (Legal Business Name): MISS JOCELYN A VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 BEAVER WOOD CT NW
ALBUQUERQUE NM
87120-6563
US

IV. Provider business mailing address

7405 BEAVER WOOD CT NW
ALBUQUERQUE NM
87120-6563
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-9901
  • Fax:
Mailing address:
  • Phone: 505-322-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: