Provider Demographics
NPI:1679110746
Name:DARST, VAUGHN (RD)
Entity type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:
Last Name:DARST
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 S PLYMOUTH BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6881
Mailing Address - Country:US
Mailing Address - Phone:562-290-2431
Mailing Address - Fax:562-264-1215
Practice Address - Street 1:1231 S PLYMOUTH BLVD APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6881
Practice Address - Country:US
Practice Address - Phone:562-290-2431
Practice Address - Fax:562-264-1215
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86107794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86107794OtherCOMMISSION ON DIETETIC REGISTRATION