Healthcare Provider Details

I. General information

NPI: 1528234200
Provider Name (Legal Business Name): ERIN VAUGHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDREN'S PLACE MB01
MADERA CA
93636
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # MB01
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6425
  • Fax:
Mailing address:
  • Phone: 559-353-6425
  • Fax: 559-353-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC186374
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.207578
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC186374
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.207578
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: