Provider Demographics
NPI:1922142199
Name:VAUGHN, LESLIE DIANE (CFM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DIANE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4673
Mailing Address - Country:US
Mailing Address - Phone:310-278-7987
Mailing Address - Fax:310-278-2593
Practice Address - Street 1:9230 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4673
Practice Address - Country:US
Practice Address - Phone:310-278-7987
Practice Address - Fax:310-278-2593
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1320270001Medicare UPIN