Provider Demographics
NPI:1932316593
Name:LOPEZ DE VAUGHAN, ROSALBA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSALBA
Middle Name:M
Last Name:LOPEZ DE VAUGHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:381 W NORTHWEST HWY
Mailing Address - Street 2:SUCCESSFUL LONGEVITY CLINIC
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2414
Mailing Address - Country:US
Mailing Address - Phone:847-705-7199
Mailing Address - Fax:847-705-7112
Practice Address - Street 1:381 W NORTHWEST HWY
Practice Address - Street 2:SUCCESSFUL LONGEVITY CLINIC
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2414
Practice Address - Country:US
Practice Address - Phone:847-705-7199
Practice Address - Fax:847-705-7112
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist