Healthcare Provider Details

I. General information

NPI: 1821306630
Provider Name (Legal Business Name): FERNANDO A VIGIL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 GOLF COURSE RD NW STE 201
ALBUQUERQUE NM
87114-5917
US

IV. Provider business mailing address

10511 GOLF COURSE RD NW STE 201
ALBUQUERQUE NM
87114-5917
US

V. Phone/Fax

Practice location:
  • Phone: 505-232-1180
  • Fax:
Mailing address:
  • Phone: 505-750-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2010-0026
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: