Individual
ALEXANDRA ARD VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10666 N TORREY PINES RD, LA JOLLA, CA 92037-1027
(858) 554-4310
Mailing address
10170 SORRENTO VALLEY RD, MAIL DROP SV-5, SAN DIEGO, CA 92121-1604
(858) 784-5888
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21317
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EJ473Z
MEDICARE PTAN
CA
Enumeration date
11/22/2010
Last updated
07/14/2014
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