Healthcare Provider Details

I. General information

NPI: 1457933087
Provider Name (Legal Business Name): ALEXANDRIA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

IV. Provider business mailing address

2625 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-6215
  • Fax:
Mailing address:
  • Phone: 405-945-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: