Healthcare Provider Details

I. General information

NPI: 1295848430
Provider Name (Legal Business Name): KIMBERLY L VIGIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7705 SE DIVISION ST
PORTLAND OR
97206-1059
US

IV. Provider business mailing address

7705 SE DIVISION ST
PORTLAND OR
97206-1059
US

V. Phone/Fax

Practice location:
  • Phone: 503-777-3311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00038217
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21889
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: