Provider Demographics
NPI:1417103425
Name:SERGIO J. VIGNALI,M.D.,LLC
Entity Type:Organization
Organization Name:SERGIO J. VIGNALI,M.D.,LLC
Other - Org Name:FEMMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:VIGNALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-297-0300
Mailing Address - Street 1:11300 LINDBERGH BLVD
Mailing Address - Street 2:STE 103. PMB 109
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8827
Mailing Address - Country:US
Mailing Address - Phone:239-226-0003
Mailing Address - Fax:239-344-9942
Practice Address - Street 1:14421 METROPOLIS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4323
Practice Address - Country:US
Practice Address - Phone:239-226-0003
Practice Address - Fax:239-344-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-10
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000256300Medicaid