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NPI Code Detail

MEDICARE: JORGE LUIS VIGOREAUXARRIETA

MEDICARE: JORGE LUIS VIGOREAUXARRIETA
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
1171000000XMilitary Health Care Provider
2390200000XStudent in an Organized Health Care Education/Training Program
3163W00000XRegistered Nurse200266-30WI

General Provider Information

NPI Number : 1194657262
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE LUIS VIGOREAUXARRIETA
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 726-582-4180
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 726-582-4180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/03/2026

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Directions to “ JORGE LUIS VIGOREAUXARRIETA ” Practice Location

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