| Carlos R. Vigil, D.o. (a Professional Corporation) | |
|
7974 Haven Ave Suite 210 Rancho Cucamonga CA 91730-3052 | |
| (909) 941-0661 | |
| (909) 948-5577 |
| Full Name | Carlos R. Vigil, D.o. (a Professional Corporation) |
|---|---|
| Speciality | Clinic/Center |
| Location | 7974 Haven Ave, Rancho Cucamonga, California |
| Authorized Official Name and Position | Susan Vigil (MANAGER) |
| Authorized Official Contact | 9099410661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlos R. Vigil, D.o. (a Professional Corporation) 7974 Haven Ave Suite 210 Rancho Cucamonga CA 91730-3052 Ph: (909) 941-0661 | Carlos R. Vigil, D.o. (a Professional Corporation) 7974 Haven Ave Suite 210 Rancho Cucamonga CA 91730-3052 Ph: (909) 941-0661 |
| NPI Number | 1003053398 |
|---|---|
| Provider Enumeration Date | 01/08/2009 |
| Last Update Date | 01/08/2009 |
| Medicare PECOS PAC ID | 1456415843 |
|---|---|
| Medicare Enrollment ID | O20090129000557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003053398 | NPI | - | NPPES |
| 00AX74460 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 20A7446 (California) | Primary |
| Provider Name | Carlos R Vigil |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366494015 PECOS PAC ID: 8921045816 Enrollment ID: I20050412001093 |
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Deepak Thiagarajan, A Professional Medical Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7974 Haven Ave Ste 210, Rancho Cucamonga, CA 91730 Phone: 909-881-5994 | |
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