Provider Demographics
NPI:1730149493
Name:VIGIL, DIANA M (AUD,CCC-A)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:VIGIL
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:CALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:2060 MAIN ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6368
Mailing Address - Country:US
Mailing Address - Phone:505-916-5977
Mailing Address - Fax:505-916-5976
Practice Address - Street 1:7801 ACADEMY RD NE STE 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3379
Practice Address - Country:US
Practice Address - Phone:505-796-4575
Practice Address - Fax:505-796-4575
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2247231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist