Provider Demographics
NPI:1821306630
Name:VIGIL, FERNANDO A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:A
Last Name:VIGIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10511 GOLF COURSE RD NW STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5917
Mailing Address - Country:US
Mailing Address - Phone:505-750-2876
Mailing Address - Fax:
Practice Address - Street 1:10511 GOLF COURSE RD NW STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5917
Practice Address - Country:US
Practice Address - Phone:505-232-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2010-0026363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical