Healthcare Provider Details

I. General information

NPI: 1801411970
Provider Name (Legal Business Name): CINDY VASQUEZ VIGIL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 SAN CARLOS DR
SPRING VALLEY CA
91978-1028
US

IV. Provider business mailing address

3219 SAN CARLOS DR
SPRING VALLEY CA
91978-1028
US

V. Phone/Fax

Practice location:
  • Phone: 619-317-8887
  • Fax:
Mailing address:
  • Phone: 619-317-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number697541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: