Healthcare Provider Details

I. General information

NPI: 1013825207
Provider Name (Legal Business Name): RHYS EDMUND VAUGHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 PACIFIC AVE
STOCKTON CA
95211-0110
US

IV. Provider business mailing address

18711 MONTE VISTA DR
LINDEN CA
95236-9544
US

V. Phone/Fax

Practice location:
  • Phone: 209-351-7537
  • Fax:
Mailing address:
  • Phone: 209-351-7537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: