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General NPI Number Information
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NPI Number | 1417103425
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Entity Type | Organization
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Legal Business Name | SERGIO J. VIGNALI,M.D.,LLC
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Dates
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Enumeration Date | 08/10/2008
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 14421 METROPOLIS AVE SUITE 103
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City | FORT MYERS
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State | FL
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Zip | 33912-4323
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Country | US
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Telephone | 239-226-0003
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Fax | 239-344-9942
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Provider Business Mailing Address
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Address Line | 11300 LINDBERGH BLVD STE 103. PMB 109
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City | FORT MYERS
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State | FL
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Zip | 33913-8827
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Country | US
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Telephone | 239-226-0003
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Fax | 239-344-9942
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Authorized Official
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Title or Position | OWNER
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Name | DR. SERGIO JUAN VIGNALI
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Credential | M.D.
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Telephone | 305-297-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME97991
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License Number State | FL
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