Healthcare Provider Details

I. General information

NPI: 1447312111
Provider Name (Legal Business Name): MARY ANN VIGILANTI ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 B ST
HAYWARD CA
94541-2917
US

IV. Provider business mailing address

6216 LAIRD AVE
OAKLAND CA
94605-1723
US

V. Phone/Fax

Practice location:
  • Phone: 510-635-1588
  • Fax:
Mailing address:
  • Phone: 510-632-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 8374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: