Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 3063 | NM |
NPI | 1780869255 |
---|---|
Provider Name | Lou G. Mazon-Vigil |
First Address | Grants, NM 87020-2204 |
Second Address | Grants, NM 87020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2008 |
Last Update Date | 03/01/2008 |