Provider Demographics
NPI:1235163163
Name:TECCA, DONALD P (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:TECCA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7830 CLAIREMONT MESA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1619
Mailing Address - Country:US
Mailing Address - Phone:858-268-1111
Mailing Address - Fax:858-268-0761
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1619
Practice Address - Country:US
Practice Address - Phone:858-268-1111
Practice Address - Fax:858-268-0761
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG45791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952818055OtherTAX ID
CA00G457910Medicaid
CA00G457910Medicaid
CAF00355Medicare UPIN