Healthcare Provider Details

I. General information

NPI: 1770215089
Provider Name (Legal Business Name): ADRIANA LORENA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 S SAN PEDRO ST
LOS ANGELES CA
90003-3030
US

IV. Provider business mailing address

8220 S SAN PEDRO ST
LOS ANGELES CA
90003-3030
US

V. Phone/Fax

Practice location:
  • Phone: 661-864-6420
  • Fax:
Mailing address:
  • Phone: 661-864-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: