Healthcare Provider Details

I. General information

NPI: 1932289626
Provider Name (Legal Business Name): JOHN C. VAUGHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE SUITE 650
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

9850 GENESEE AVE SUITE 650
LA JOLLA CA
92037-1224
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-4327
  • Fax: 858-452-5960
Mailing address:
  • Phone: 858-452-4327
  • Fax: 858-452-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberC39897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: