Healthcare Provider Details

I. General information

NPI: 1447763651
Provider Name (Legal Business Name): REINA VIGIL-SANCHEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EL LLANO RD
ESPANOLA NM
87532-6727
US

IV. Provider business mailing address

PO BOX 435
CHIMAYO NM
87522-0435
US

V. Phone/Fax

Practice location:
  • Phone: 505-367-3420
  • Fax: 505-753-6177
Mailing address:
  • Phone: 505-367-3420
  • Fax: 505-753-6177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR49972
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: