Healthcare Provider Details

I. General information

NPI: 1548526619
Provider Name (Legal Business Name): ALAN JUSTIN VIGLIONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 10/04/2023
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 COAST VILLAGE RD
MONTECITO CA
93108-2716
US

IV. Provider business mailing address

1127 COAST VILLAGE RD
MONTECITO CA
93108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 805-892-6500
  • Fax: 805-209-0972
Mailing address:
  • Phone: 805-892-6500
  • Fax: 805-209-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA129578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: