Healthcare Provider Details

I. General information

NPI: 1841015112
Provider Name (Legal Business Name): MR. BRETT MATTHEW VIGIL I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 ARTESIA BLVD
BELLFLOWER CA
90706-6713
US

IV. Provider business mailing address

5426 E WARDLOW RD
LONG BEACH CA
90808-3558
US

V. Phone/Fax

Practice location:
  • Phone: 562-484-3385
  • Fax:
Mailing address:
  • Phone: 562-896-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: