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NPI Code Detail

MEDICARE: WINSTON CANUTE VAUGHAN M.D.

MEDICARE: WINSTON CANUTE VAUGHAN M.D.
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
1174400000XSpecialistG77809CA

General Provider Information

NPI Number : 1821182973
Entity Type Code : Individual
Provider Name (Legal Business Name) : WINSTON CANUTE VAUGHAN M.D.
Provider Business Mailing Address
First Line : 1111 EXPOSITION BLVD
Second Line : BLDG 700
City : SACRAMENTO
State : CA
Zip : 95815-4314
Country : US
Telephone Number : 916-736-3408
Fax Number : 916-233-4171
Provider Business Practice Location Address
First Line : 3351 EL CAMINO REAL
Second Line : STE 200
City : ATHERTON
State : CA
Zip : 94027-3811
Country : US
Telephone Number : 650-399-4630
Fax Number : 650-366-4930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 10/19/2015

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