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General NPI Number Information
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NPI Number | 1639523699
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Entity Type | Organization
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Legal Business Name | STUDIO VSC PREVENTIVE HEALTH MAINTENANCE OF THE FEET
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 910 8TH ST SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-4006
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Country | US
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Telephone | 505-516-9869
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Fax |
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Provider Business Mailing Address
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Address Line | 910 8TH ST SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-4006
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Country | US
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Telephone | 505-516-9869
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Fax |
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Authorized Official
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Title or Position | REGISTERED COSMETOLOGIST
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Name | VIRGINIA S CHAVIRA
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Credential | R.C
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Telephone | 505-516-9869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | CO039083
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License Number State | NM
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