1245417856 NPI number — DR. SILVIA VAUGHN PSY.D.

Table of content: DR. SILVIA VAUGHN PSY.D. (NPI 1245417856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245417856 NPI number — DR. SILVIA VAUGHN PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHN
Provider First Name:
SILVIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SADY-KENNEDY
Provider Other First Name:
SILVIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245417856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5762 BOLSA AVE STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92649-1172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-898-0362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23600 EL TORO RD # D163
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-683-3229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY21564 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)