Provider Demographics
NPI:1548325368
Name:VIGIL, MARIA E (HAD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:VIGIL
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 WHITTIER BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4129
Mailing Address - Country:US
Mailing Address - Phone:323-721-6424
Mailing Address - Fax:323-728-5375
Practice Address - Street 1:5615 WHITTIER BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-4129
Practice Address - Country:US
Practice Address - Phone:323-721-6424
Practice Address - Fax:323-728-5375
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1589237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0015890Medicaid