Provider Demographics
NPI:1073877247
Name:JAMES R. VEVAINA, M.D. (CORP.)
Entity Type:Organization
Organization Name:JAMES R. VEVAINA, M.D. (CORP.)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:VEVAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-581-0400
Mailing Address - Street 1:8929 UNIVERSITY CENTER LANE
Mailing Address - Street 2:SUITE 100.
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1006
Mailing Address - Country:US
Mailing Address - Phone:858-581-0400
Mailing Address - Fax:858-581-0070
Practice Address - Street 1:8929 UNIVERSITY CENTER LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1006
Practice Address - Country:US
Practice Address - Phone:858-581-0400
Practice Address - Fax:858-581-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30551207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A305510Medicaid
CAB17953Medicare UPIN
CA00A305510Medicaid