Healthcare Provider Details

I. General information

NPI: 1154225936
Provider Name (Legal Business Name): LEONARD VIGIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 E ORCHARD RD STE A
LITTLETON CO
80121-8055
US

IV. Provider business mailing address

191 E ORCHARD RD STE A
LITTLETON CO
80121-8055
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-2064
  • Fax: 303-830-2524
Mailing address:
  • Phone: 303-830-2064
  • Fax: 303-830-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: