Provider Demographics
NPI:1568886109
Name:GONZALES-VIGILAR PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:GONZALES-VIGILAR PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:VIGILAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-291-2449
Mailing Address - Street 1:42455 BELMONT GLEN PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4320
Mailing Address - Country:US
Mailing Address - Phone:571-291-2449
Mailing Address - Fax:
Practice Address - Street 1:44031 PIPELINE PLZ STE 205
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5888
Practice Address - Country:US
Practice Address - Phone:571-291-2449
Practice Address - Fax:571-291-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty