Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G76613 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | G76613 | CA |
NPI | 1184795155 |
---|---|
Provider Name | Daniel V. Vigil |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 25/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184795155 | (05) | CA |