Healthcare Provider Details

I. General information

NPI: 1073824249
Provider Name (Legal Business Name): CAITLIN VIGIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN DUFAULT MD

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 24TH ST
PUEBLO CO
81003-1411
US

IV. Provider business mailing address

13001 E 17TH PL # Q20C2000
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-4000
  • Fax:
Mailing address:
  • Phone: 303-724-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRS2011-0397
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46168
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0060188
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0060188
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number0060188
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: