Provider Demographics
NPI:1740238104
Name:VAUX, KEITH KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:KENNETH
Last Name:VAUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-0666
Mailing Address - Country:US
Mailing Address - Phone:619-940-4445
Mailing Address - Fax:858-345-5019
Practice Address - Street 1:5801 LOMA VERDE DR
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067-9561
Practice Address - Country:US
Practice Address - Phone:619-940-4445
Practice Address - Fax:858-345-5019
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87297208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics