Individual
JIM VIGIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 N DATE ST, T OR C, NM 87901-2377
(575) 894-7459
Mailing address
405 N DATE ST, T OR C, NM 87901-2377
(575) 894-7459
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
351818
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351818
STATE OF NEW MEXICO PED
NM
Enumeration date
08/16/2016
Last updated
08/16/2016
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