Healthcare Provider Details

I. General information

NPI: 1821499492
Provider Name (Legal Business Name): ELIZABETH ANN VIGIL AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2014
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ESTUDILLO AVE STE 100
SAN LEANDRO CA
94577-4962
US

IV. Provider business mailing address

400 ESTUDILLO AVE STE 100
SAN LEANDRO CA
94577-4962
US

V. Phone/Fax

Practice location:
  • Phone: 510-924-0548
  • Fax:
Mailing address:
  • Phone: 510-924-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF123760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF83761
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT123760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: