Healthcare Provider Details

I. General information

NPI: 1790498848
Provider Name (Legal Business Name): ASHLEE VIGANO AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8190 ORCHARD ST
ALTA LOMA CA
91701-1814
US

IV. Provider business mailing address

8190 ORCHARD ST
ALTA LOMA CA
91701-1814
US

V. Phone/Fax

Practice location:
  • Phone: 909-268-6129
  • Fax:
Mailing address:
  • Phone: 909-268-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: