Provider Demographics
NPI:1558619817
Name:VAUGHN, PAUL EVAN
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EVAN
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 5TH AVE
Mailing Address - Street 2:APT #4
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2667
Mailing Address - Country:US
Mailing Address - Phone:415-518-4211
Mailing Address - Fax:
Practice Address - Street 1:1366 5TH AVE
Practice Address - Street 2:APT #4
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2667
Practice Address - Country:US
Practice Address - Phone:415-518-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant