Individual
IVAN VIGOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2920 N 4TH ST, FLAGSTAFF, AZ 86004-1816
(928) 522-9400
Mailing address
7520 OMNI LN APT 301, FORT MYERS, FL 33905-5477
(813) 400-6742
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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