Healthcare Provider Details

I. General information

NPI: 1922879485
Provider Name (Legal Business Name): DEBBIE VERONICA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 STATE HWY. 96
GALLINA NM
87017
US

IV. Provider business mailing address

PO BOX 230
GALLINA NM
87017-0230
US

V. Phone/Fax

Practice location:
  • Phone: 575-638-5491
  • Fax: 575-638-5571
Mailing address:
  • Phone: 575-638-5491
  • Fax: 575-638-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR37179
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: