Provider Demographics
NPI:1306868328
Name:VECCHIONE, RANDAL JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:JOHN
Last Name:VECCHIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6537
Mailing Address - Country:US
Mailing Address - Phone:619-234-1674
Mailing Address - Fax:619-234-1680
Practice Address - Street 1:2542 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6537
Practice Address - Country:US
Practice Address - Phone:619-234-1674
Practice Address - Fax:619-234-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA341542086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341540Medicaid
CA00A341540Medicaid
A27395Medicare ID - Type Unspecified