Basic Information
| Provider Information | |||||||||
| NPI: | 1003337148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIGUERAS | ||||||||
| FirstName: | VARINIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VIGUERAS ROBLES LINARES | ||||||||
| OtherFirstName: | VARINIA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6505 COMPTON BLVD SE | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985136228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532322062 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4110 BRIARGATE PKWY STE 460 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809207839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193646488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2017 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0006271 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA.PA.60772987 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.