Healthcare Provider Details

I. General information

NPI: 1528871985
Provider Name (Legal Business Name): JENNIFER VIGIL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 GESNER ST STE 207
SAN DIEGO CA
92117-6685
US

IV. Provider business mailing address

4305 GESNER ST STE 207
SAN DIEGO CA
92117-6685
US

V. Phone/Fax

Practice location:
  • Phone: 951-553-3731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: