Healthcare Provider Details

I. General information

NPI: 1780233221
Provider Name (Legal Business Name): ROBERT ROSCOE VAUGHAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 EL CAMINO REAL
CARLSBAD CA
92008-1273
US

IV. Provider business mailing address

2510 EL CAMINO REAL
CARLSBAD CA
92008-1273
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-8941
  • Fax:
Mailing address:
  • Phone: 760-729-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: