Provider Demographics
NPI:1306637541
Name:VIGIL, MARISSA N
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:N
Last Name:VIGIL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 OLGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-3529
Mailing Address - Country:US
Mailing Address - Phone:210-309-1086
Mailing Address - Fax:
Practice Address - Street 1:102 OLGA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3529
Practice Address - Country:US
Practice Address - Phone:210-309-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician