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General NPI Number Information
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NPI Number | 1497799589
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Entity Type | Individual
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Provider Name | ANASTACIO VIGIL MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 1260 15TH ST 1501
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City | SANTA MONICA
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State | CA
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Zip | 90404-1135
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Country | US
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Telephone | 310-656-1700
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Fax | 310-458-1061
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-656-1701
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Fax | 310-458-1061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A43696
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License Number State | CA
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