Healthcare Provider Details

I. General information

NPI: 1639399967
Provider Name (Legal Business Name): PATRICK NORMAN VIGIL II MT (AAB)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 ABALONE LOOP RD
MESCALERO NM
88340
US

IV. Provider business mailing address

PO BOX 523
LA LUZ NM
88337-0523
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-4441
  • Fax: 505-464-4422
Mailing address:
  • Phone: 505-434-1780
  • Fax: 505-434-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: