Healthcare Provider Details

I. General information

NPI: 1558484220
Provider Name (Legal Business Name): MRS. MARY VAUGHN SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARY VAUGHN INGENTHRON

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 MOUNTAIN BLVD BUILDING 69
OAKLAND CA
94605-4500
US

IV. Provider business mailing address

8750 MOUNTAIN BLVD BUILDING 69
OAKLAND CA
94605-4500
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: