MEDICARE: DR. VIVIAN A. FERNANDEZ GEILIN PH.D.

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	101YP2500X	Professional Counselor	1290	NM

General Provider Information

NPI Number	:	1891846259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN A. FERNANDEZ GEILIN PH.D.

Provider Business Mailing Address
First Line	:	416 EL DORADO DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-1709
Country	:	US
Telephone Number	:	505-321-0833
Fax Number	:	505-244-3408

Provider Business Practice Location Address
First Line	:	612 ENCINO PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2602
Country	:	US
Telephone Number	:	505-321-0833
Fax Number	:

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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