Provider Demographics
NPI:1780677153
Name:MARTINEZ-VIGIL, CHRISTINE E (PHC,RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:E
Last Name:MARTINEZ-VIGIL
Suffix:
Gender:F
Credentials:PHC,RPH
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:E
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHC,RPH
Mailing Address - Street 1:538 N PASEO DE ONATE
Mailing Address - Street 2:P.O. BOX 158
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2618
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5815
Practice Address - Street 1:2010 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3600
Practice Address - Country:US
Practice Address - Phone:505-753-7218
Practice Address - Fax:505-753-5815
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005496183500000X
NMPC00000038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73244Medicaid