MEDICARE: DIANA M. VIGIL AU.D.,CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	2247	NM
2	237600000X	Audiologist-Hearing Aid Fitter	2247	NM

General Provider Information

NPI Number	:	1730149493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA M. VIGIL AU.D.,CCC-A

Provider Business Mailing Address
First Line	:	2060 MAIN ST NE STE A
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-6368
Country	:	US
Telephone Number	:	505-916-5977
Fax Number	:	505-916-5976

Provider Business Practice Location Address
First Line	:	7801 ACADEMY RD NE STE 102
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3379
Country	:	US
Telephone Number	:	505-796-4575
Fax Number	:	505-796-4575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	09/01/2022

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