Provider Demographics
NPI:1033441175
Name:VIGANO, KATHLEEN MEGAN-FOX (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MEGAN-FOX
Last Name:VIGANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46690 MOHAVE DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7001
Mailing Address - Country:US
Mailing Address - Phone:510-651-2371
Mailing Address - Fax:510-661-0380
Practice Address - Street 1:46690 MOHAVE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7001
Practice Address - Country:US
Practice Address - Phone:510-651-2371
Practice Address - Fax:510-661-0380
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant