Healthcare Provider Details

I. General information

NPI: 1407465271
Provider Name (Legal Business Name): JOSEROSARIO VIGIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WASHBURN ST
SAN FRANCISCO CA
94103-2663
US

IV. Provider business mailing address

1385 MISSION ST STE 200
SAN FRANCISCO CA
94103-2631
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-8701
  • Fax: 415-864-0682
Mailing address:
  • Phone: 415-864-7833
  • Fax: 415-864-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT135977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: