Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | A87297 | CA |
Y | 208000000X | Pediatrician | A87297 | CA |
NPI | 1740238104 |
---|---|
Provider Name | Keith Kenneth Vaux |
First Address | San Diego, CA 92106-6135 |
Second Address | San Diego, CA 92106-6135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 29/12/2015 |