Healthcare Provider Details

I. General information

NPI: 1497619472
Provider Name (Legal Business Name): ALEXIS VANGAARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S BASCOM AVE STE 1014
SAN JOSE CA
95128-3537
US

IV. Provider business mailing address

950 S BASCOM AVE STE 1014
SAN JOSE CA
95128-3537
US

V. Phone/Fax

Practice location:
  • Phone: 408-471-4261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: