Provider Demographics
NPI:1962427419
Name:VAUSE, KAREN L (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:VAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261791
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-1791
Mailing Address - Country:US
Mailing Address - Phone:818-995-0640
Mailing Address - Fax:818-881-7566
Practice Address - Street 1:16677 CALNEVA DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4167
Practice Address - Country:US
Practice Address - Phone:818-995-0640
Practice Address - Fax:818-881-7566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG460192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG46019OtherMEDICARE PTAN
CA00G46019Medicaid
CAWG46019OtherMEDICARE PTAN