Healthcare Provider Details

I. General information

NPI: 1932744778
Provider Name (Legal Business Name): VERONICA L VIGIL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUENO DE VIGIL RD
ESPANOLA NM
87532-9488
US

IV. Provider business mailing address

1921 AVENIDA CANADA
ESPANOLA NM
87532-2902
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-9532
  • Fax:
Mailing address:
  • Phone: 505-412-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8374
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: