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General NPI Number Information
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NPI Number | 1659672632
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Entity Type | Individual
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Provider Name | MOSES EDWARD VIGIL L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 208 W 8TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-3023
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Country | US
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Telephone | 719-671-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 2912 40TH LN
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City | AVONDALE
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State | CO
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Zip | 81022-9810
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Country | US
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Telephone | 719-671-7570
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Fax | 719-543-8352
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 991712
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License Number State | CO
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