Healthcare Provider Details

I. General information

NPI: 1891297412
Provider Name (Legal Business Name): CATHERINE MACE VITUG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MACE

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DAYTON AVE
SAN LEANDRO CA
94579-1528
US

IV. Provider business mailing address

17572 VIA RINCON
SAN LORENZO CA
94580-3223
US

V. Phone/Fax

Practice location:
  • Phone: 510-317-3679
  • Fax:
Mailing address:
  • Phone: 408-966-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: