Provider Demographics
NPI:1558834705
Name:PEOPLES, VISHNA (CPSW)
Entity Type:Individual
Prefix:
First Name:VISHNA
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:VISHNA
Other - Middle Name:
Other - Last Name:MORGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPSW
Mailing Address - Street 1:614 MCADOO ST STE B
Mailing Address - Street 2:
Mailing Address - City:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-2706
Mailing Address - Country:US
Mailing Address - Phone:575-297-0171
Mailing Address - Fax:575-894-7383
Practice Address - Street 1:614 MCADOO ST STE B
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-2706
Practice Address - Country:US
Practice Address - Phone:575-297-0171
Practice Address - Fax:575-894-7383
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM829175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist