Provider Demographics
NPI:1619746484
Name:VIGESAA, JULIA CAMILLE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:CAMILLE
Last Name:VIGESAA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 CORONA DR STE 260
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4395
Mailing Address - Country:US
Mailing Address - Phone:979-774-2244
Mailing Address - Fax:
Practice Address - Street 1:3025 QUAIL SPRINGS RD APT B11
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3705
Practice Address - Country:US
Practice Address - Phone:406-861-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX435812355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant