Provider Demographics
NPI:1639523699
Name:STUDIO VSC PREVENTIVE HEALTH MAINTENANCE OF THE FEET
Entity Type:Organization
Organization Name:STUDIO VSC PREVENTIVE HEALTH MAINTENANCE OF THE FEET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED COSMETOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAVIRA
Authorized Official - Suffix:
Authorized Official - Credentials:RC
Authorized Official - Phone:505-516-9869
Mailing Address - Street 1:910 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4006
Mailing Address - Country:US
Mailing Address - Phone:505-516-9869
Mailing Address - Fax:
Practice Address - Street 1:910 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4006
Practice Address - Country:US
Practice Address - Phone:505-516-9869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCO039083302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM080160135OtherUS FEDERAL SYSTEM OF AWARD MANAGEMENT BELOW IS DUNS # HERE IS CAGE CODE 7KCN9