Provider Demographics
NPI:1982607990
Name:COOPER VAUGHN, MARGARET V (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:V
Last Name:COOPER VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0021
Mailing Address - Country:US
Mailing Address - Phone:800-967-2289
Mailing Address - Fax:760-320-1805
Practice Address - Street 1:815 POLLARD RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1438
Practice Address - Country:US
Practice Address - Phone:800-967-2289
Practice Address - Fax:760-320-1805
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA453054970OtherTAX ID