Individual
MISS CODI N VIGIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1303 GRAY WOLF CIR, PUEBLO, CO 81001-4931
(719) 565-7315
Mailing address
1303 GRAY WOLF CIR, PUEBLO, CO 81001-4931
(719) 565-7315
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
CO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CO
Other
Enumeration date
11/07/2018
Last updated
11/07/2018
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