Provider Demographics
NPI:1790320083
Name:RELANO, VAUGHN L (NP)
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:L
Last Name:RELANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 PINOCHE PEAK WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7730
Mailing Address - Country:US
Mailing Address - Phone:909-904-3616
Mailing Address - Fax:
Practice Address - Street 1:4035 PINOCHE PEAK WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-7730
Practice Address - Country:US
Practice Address - Phone:909-904-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95013134363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care