Individual
DESIRAE RENEE VIGIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A.P
Contact information
Practice address
12840 HOLLY ST UNIT 120, THORNTON, CO 80602-8289
(720) 232-7135
Mailing address
12840 HOLLY ST UNIT 120, THORNTON, CO 80602-8289
(720) 232-7135
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
COZ720555
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COZ720555
DORA
CO
Enumeration date
07/11/2022
Last updated
07/11/2022
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