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General NPI Number Information
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NPI Number | 1275760407
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Entity Type | Individual
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Provider Name | JAMES VAUGHN ATC
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Gender | Male
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 313 KENDAL ST STE B
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City | VACAVILLE
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State | CA
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Zip | 95688-3960
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Country | US
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Telephone | 707-474-7475
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 996
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-0996
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Country | US
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Telephone | 707-474-7475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 5161
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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