Provider Demographics
NPI:1871232900
Name:VAUGHN, SURMICHE (CMT)
Entity Type:Individual
Prefix:MS
First Name:SURMICHE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 EMBARCADERO STE D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5117
Mailing Address - Country:US
Mailing Address - Phone:510-688-2919
Mailing Address - Fax:
Practice Address - Street 1:1211 EMBARCADERO STE D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5117
Practice Address - Country:US
Practice Address - Phone:510-328-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist