Healthcare Provider Details

I. General information

NPI: 1336650753
Provider Name (Legal Business Name): DAMISO SAEED VAUGHNS CERTIFICATION
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

IV. Provider business mailing address

347 W 78TH ST
LOS ANGELES CA
90003-2413
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4545
  • Fax: 562-869-1835
Mailing address:
  • Phone: 323-535-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9755-R
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: