Healthcare Provider Details

I. General information

NPI: 1104940717
Provider Name (Legal Business Name): SUSAN VIGIL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE 2ND FLOOR MAIL ROOM
ORANGE CA
92868-4231
US

IV. Provider business mailing address

104 VIA MENTONE
NEWPORT BEACH CA
92663-4917
US

V. Phone/Fax

Practice location:
  • Phone: 714-347-3296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: