Healthcare Provider Details

I. General information

NPI: 1437766912
Provider Name (Legal Business Name): TORY DAVID VIGIL SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PLUMAS BLVD
YUBA CITY CA
95991-5081
US

IV. Provider business mailing address

410 GREG THATCH CIR
SACRAMENTO CA
95835-2424
US

V. Phone/Fax

Practice location:
  • Phone: 530-552-0056
  • Fax:
Mailing address:
  • Phone: 916-834-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: