Provider Demographics
NPI:1962552349
Name:VIGO PAREDES, ELVIN (MD)
Entity type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:
Last Name:VIGO PAREDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0997
Mailing Address - Country:US
Mailing Address - Phone:787-826-0440
Mailing Address - Fax:787-826-0440
Practice Address - Street 1:37 CALLE SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2929
Practice Address - Country:US
Practice Address - Phone:787-826-0440
Practice Address - Fax:787-826-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9539208D00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care