Provider Demographics
NPI:1497799589
Name:VIGIL, ANASTACIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTACIO
Middle Name:
Last Name:VIGIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-656-1701
Mailing Address - Fax:310-458-1061
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:1501
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-656-1700
Practice Address - Fax:310-458-1061
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA43696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC22979Medicare UPIN