Healthcare Provider Details

I. General information

NPI: 1578230801
Provider Name (Legal Business Name): VIGIA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10887 NW 17TH ST UNIT 108A
MIAMI FL
33172-2044
US

IV. Provider business mailing address

10887 NW 17TH ST UNIT 108A
MIAMI FL
33172-2044
US

V. Phone/Fax

Practice location:
  • Phone: 786-493-2293
  • Fax:
Mailing address:
  • Phone: 786-493-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. YURI SALAS ESPINOSA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 786-493-2293