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General NPI Number Information
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NPI Number | 1821306630
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Entity Type | Individual
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Provider Name | FERNANDO A VIGIL PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 10511 GOLF COURSE RD NW STE 201
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5917
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Country | US
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Telephone | 505-232-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 10511 GOLF COURSE RD NW STE 201
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5917
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Country | US
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Telephone | 505-750-2876
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2010-0026
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License Number State | NM
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