Provider Demographics
NPI:1407886302
Name:VIGIL, ISABEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:C
Last Name:VIGIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:156 WYATT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2996
Mailing Address - Country:US
Mailing Address - Phone:505-522-1628
Mailing Address - Fax:505-522-1636
Practice Address - Street 1:156 WYATT DR STE 1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2996
Practice Address - Country:US
Practice Address - Phone:505-522-1628
Practice Address - Fax:505-522-1636
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38083Medicaid
NMC98275Medicare UPIN
NM400521164Medicare PIN