Healthcare Provider Details

I. General information

NPI: 1386732360
Provider Name (Legal Business Name): MRS. LUCILLE V VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOT SPRINGS BLVD
LAS VEGAS NM
87701
US

IV. Provider business mailing address

730 WILLIAMS DRIVE #14
LAS VEGAS NM
87701
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6768
  • Fax: 505-438-0051
Mailing address:
  • Phone: 505-617-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL17432
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: