Provider Demographics
NPI:1245392497
Name:HOGGATT, AMANDA (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HOGGATT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:315 N ASSOCIATED RD APT 608
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4307
Mailing Address - Country:US
Mailing Address - Phone:714-256-9022
Mailing Address - Fax:
Practice Address - Street 1:1215 W WEST COVINA PKWY # 200
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2815
Practice Address - Country:US
Practice Address - Phone:626-338-9200
Practice Address - Fax:626-856-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 39731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist