Provider Demographics
NPI:1376514190
Name:VIGNA, GREG ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:ANTHONY
Last Name:VIGNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3757
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:1303 MABLE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-0001
Practice Address - Country:US
Practice Address - Phone:209-857-3400
Practice Address - Fax:805-564-3332
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1469208100000X
IN01075520A208100000X
OH35141611208100000X
CAC54741208100000X
MT85785208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201299460Medicaid
IN264220008Medicare PIN