MEDICARE: VIVIAN VAUGHAN LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC8948	CA

General Provider Information

NPI Number	:	1548324981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN VAUGHAN LAC

Provider Business Mailing Address
First Line	:	9972 CAMPO RD
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-1611
Country	:	US
Telephone Number	:	619-469-6327
Fax Number	:

Provider Business Practice Location Address
First Line	:	9972 CAMPO RD
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-1611
Country	:	US
Telephone Number	:	619-469-6327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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