Healthcare Provider Details

I. General information

NPI: 1487934816
Provider Name (Legal Business Name): ALAN GREGORY VAUGHAN PH.D., JD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 COLLEGE AVE
OAKLAND CA
94618-1599
US

IV. Provider business mailing address

4451 SAINT ANDREWS RD
OAKLAND CA
94605-4531
US

V. Phone/Fax

Practice location:
  • Phone: 510-383-1120
  • Fax:
Mailing address:
  • Phone: 510-383-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: