Provider Demographics
NPI:1457842908
Name:VAUGHN, ALEXANDRA ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ROCHELLE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 BLUE RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4771
Mailing Address - Country:US
Mailing Address - Phone:916-983-3373
Mailing Address - Fax:
Practice Address - Street 1:192 BLUE RAVINE RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4771
Practice Address - Country:US
Practice Address - Phone:916-938-3373
Practice Address - Fax:916-983-7037
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA165516207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program