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General NPI Number Information
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NPI Number | 1760620884
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Entity Type | Organization
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Legal Business Name | SAN DIEGO PSYCHOTHERAPY SERVICES
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 8885 RIO SAN DIEGO DR STE 365
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City | SAN DIEGO
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State | CA
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Zip | 92108-1624
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Country | US
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Telephone | 619-459-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 8885 RIO SAN DIEGO DR STE 365
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City | SAN DIEGO
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State | CA
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Zip | 92108-1624
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Country | US
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Telephone | 619-459-1688
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL VIGORITO
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Credential | MFT
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Telephone | 619-459-1688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC41512
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License Number State | CA
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