MEDICARE: DR. JOSE J VIGO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	5299	PR

General Provider Information

NPI Number	:	1043252760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE J VIGO M.D.

Provider Business Mailing Address
First Line	:	49 CALLE YAGUEZ
Second Line	:	ESTANCIAS DEL RIO
City	:	AGUAS BUENAS
State	:	PR
Zip	:	00703-9628
Country	:	US
Telephone Number	:	787-744-6071
Fax Number	:	787-744-6071

Provider Business Practice Location Address
First Line	:	435 PONCE DE LEON AVE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-3428
Country	:	US
Telephone Number	:	787-754-0909
Fax Number	:	787-772-9710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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