Healthcare Provider Details

I. General information

NPI: 1801448113
Provider Name (Legal Business Name): VIGO MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALLE SAN ANTONIO
ANASCO PR
00610-3092
US

IV. Provider business mailing address

37 CALLE SAN ANTONIO
ANASCO PR
00610-3092
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-0440
  • Fax:
Mailing address:
  • Phone: 787-826-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ELVIN VIGO PAREDES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-826-0440