Healthcare Provider Details

I. General information

NPI: 1427289628
Provider Name (Legal Business Name): ALAN ANTHONY VITOLO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 COLLEGE AVE SUITE 202-6
OAKLAND CA
94618-1598
US

IV. Provider business mailing address

5435 COLLEGE AVE SUITE 202-6
OAKLAND CA
94618-1598
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-7669
  • Fax: 510-643-5336
Mailing address:
  • Phone: 510-547-7669
  • Fax: 510-643-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 14647
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 14647
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 14647
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 14647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: