Healthcare Provider Details

I. General information

NPI: 1922253814
Provider Name (Legal Business Name): HILDA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 02/18/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1144 PAAPAANA ST
EWA BEACH HI
96706-5601
US

IV. Provider business mailing address

91-1144 PAAPAANA ST
EWA BEACH HI
96706-5601
US

V. Phone/Fax

Practice location:
  • Phone: 951-581-9699
  • Fax:
Mailing address:
  • Phone: 951-581-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3868
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95024182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: