Provider Demographics
NPI:1093932741
Name:VIGIL, SYLVIA M
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:M
Last Name:VIGIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:CA
Mailing Address - Zip Code:90704-2170
Mailing Address - Country:US
Mailing Address - Phone:310-510-7500
Mailing Address - Fax:310-510-8986
Practice Address - Street 1:125 METROPOLE AVE
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704
Practice Address - Country:US
Practice Address - Phone:310-510-7500
Practice Address - Fax:310-510-8986
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator