Healthcare Provider Details

I. General information

NPI: 1205777661
Provider Name (Legal Business Name): VIGILANCE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SAINT CHARLES DR STE 230
THOUSAND OAKS CA
91360-3990
US

IV. Provider business mailing address

555 SAINT CHARLES DR STE 230
THOUSAND OAKS CA
91360-3990
US

V. Phone/Fax

Practice location:
  • Phone: 805-823-0981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M COBURN
Title or Position: PRESIDENT
Credential: MD
Phone: 805-823-0981