Healthcare Provider Details

I. General information

NPI: 1346574225
Provider Name (Legal Business Name): MELISSA PAULETTE VIGIL-MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 INDUSTRIAL PARK RD
ESPANOLA NM
87532-3453
US

IV. Provider business mailing address

1122 INDUSTRIAL PARK RD
ESPANOLA NM
87532-3453
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-3143
  • Fax: 505-753-1769
Mailing address:
  • Phone: 505-753-3143
  • Fax: 505-753-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: