Provider Demographics
NPI:1104671288
Name:VIGIL, ALIXZANDRA A
Entity type:Individual
Prefix:
First Name:ALIXZANDRA
Middle Name:A
Last Name:VIGIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10306 20TH ST APT D307
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-0027
Mailing Address - Country:US
Mailing Address - Phone:970-817-4760
Mailing Address - Fax:
Practice Address - Street 1:10306 20TH ST APT D307
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-0027
Practice Address - Country:US
Practice Address - Phone:970-817-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician