Healthcare Provider Details

I. General information

NPI: 1114897931
Provider Name (Legal Business Name): MARIA VAUGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14407 HAMLIN ST STE A
VAN NUYS CA
91401-6200
US

IV. Provider business mailing address

14407 HAMLIN ST STE A
VAN NUYS CA
91401-6200
US

V. Phone/Fax

Practice location:
  • Phone: 424-355-9171
  • Fax:
Mailing address:
  • Phone: 424-355-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: