Healthcare Provider Details

I. General information

NPI: 1396182267
Provider Name (Legal Business Name): PATRICK DANIEL VIGIL M.D., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE STE 4003
TACOMA WA
98405-1702
US

IV. Provider business mailing address

1901 S UNION AVE STE 4003
TACOMA WA
98405-1702
US

V. Phone/Fax

Practice location:
  • Phone: 253-693-0071
  • Fax: 618-481-2593
Mailing address:
  • Phone: 253-693-0071
  • Fax: 253-693-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60375676
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60577167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: