Provider Demographics
NPI:1003813783
Name:TRIOLO, DONALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:TRIOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5253
Mailing Address - Country:US
Mailing Address - Phone:619-583-8160
Mailing Address - Fax:619-583-8170
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:SUITE 2201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5253
Practice Address - Country:US
Practice Address - Phone:619-583-8160
Practice Address - Fax:619-583-8170
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3211213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E3211Medicaid
E3211OtherSTATE LICENSE
CA480003710OtherRAILROAD MEDICARE
AT2684264OtherREA
T19282Medicare UPIN
CA480003710OtherRAILROAD MEDICARE
CA000E3211Medicaid