Provider Demographics
NPI:1932744778
Name:VIGIL, VERONICA L (LMT)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:L
Last Name:VIGIL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 AVENIDA CANADA
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2902
Mailing Address - Country:US
Mailing Address - Phone:505-412-9532
Mailing Address - Fax:
Practice Address - Street 1:5 SUENO DE VIGIL RD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-9488
Practice Address - Country:US
Practice Address - Phone:505-412-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty