Basic Information
| Provider Information | |||||||||
| NPI: | 1598284861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREG VIGNA MD CLCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 E GUTIERREZ ST STE C | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931035223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059633757 | ||||||||
| FaxNumber: | 8055643332 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 MABLE AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185482649 | ||||||||
| FaxNumber: | 8055643332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2017 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | MEYERS | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
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| AuthorizedOfficialTitleorPosition: | A/R MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8059633757 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | C54741 | SD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1376514190 | 05 | CA | MEDICAID |