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General NPI Number Information
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NPI Number | 1508037482
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Entity Type | Organization
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Legal Business Name | VIRGINIA SAN MIGUEL MD PC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 21810 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-3256
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Country | US
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Telephone | 503-656-8072
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Fax | 503-557-8012
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Provider Business Mailing Address
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Address Line | 21810 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-3256
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Country | US
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Telephone | 503-656-8072
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Fax | 503-557-8012
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIRGINIA V. SAN MIGUEL
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Credential | MD
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Telephone | 503-656-8072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD25567
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License Number State | OR
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