Healthcare Provider Details

I. General information

NPI: 1922142199
Provider Name (Legal Business Name): LESLIE DIANE VAUGHN CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 W OLYMPIC BLVD SUITE 100
BEVERLY HILLS CA
90212-4673
US

IV. Provider business mailing address

9230 W OLYMPIC BLVD SUITE 100
BEVERLY HILLS CA
90212-4673
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-7987
  • Fax: 310-278-2593
Mailing address:
  • Phone: 310-278-7987
  • Fax: 310-278-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: