Basic Information
| Provider Information | |||||||||
| NPI: | 1336650753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAUGHNS | ||||||||
| FirstName: | DAMISO | ||||||||
| MiddleName: | SAEED | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CERTIFICATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 W 78TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900032413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235352950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11500 PARAMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629234545 | ||||||||
| FaxNumber: | 5628691835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 9755-R | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.