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General NPI Number Information
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NPI Number | 1750112132
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Entity Type | Individual
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Provider Name | CRYSTAL VIGIL
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Gender | Female
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Dates
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Enumeration Date | 08/08/2024
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 5155 S DURANGO DR STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89113-0174
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Country | US
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Telephone | 702-869-4401
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Fax | 702-869-9904
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Provider Business Mailing Address
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Address Line | 3009 FERN HOLLOW CT
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City | LAS VEGAS
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State | NV
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Zip | 89108-4332
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Country | US
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Telephone | 702-241-0899
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Fax |
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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 | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | RC4009
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License Number State | NV
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