Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A41482 | CA |
NPI | 1003001132 |
---|---|
Provider Name | Michael Angelo Viggianelli |
First Address | San Luis Obispo, CA 93401-7682 |
Second Address | San Luis Obispo, CA 93409-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2007 |