Provider Demographics
NPI:1417960980
Name:VIGIL, ALBERT G (PT)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:G
Last Name:VIGIL
Suffix:
Gender:M
Credentials:PT
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 233
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93216-0233
Mailing Address - Country:US
Mailing Address - Phone:661-721-0468
Mailing Address - Fax:661-721-0537
Practice Address - Street 1:1205 GARCES HWY STE 300
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3639
Practice Address - Country:US
Practice Address - Phone:661-721-0468
Practice Address - Fax:661-721-0537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8592261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT85920Medicare UPIN