Provider Demographics
NPI:1811202740
Name:THOMAS R VECCHIONE MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS R VECCHIONE MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:VECCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-297-4433
Mailing Address - Street 1:3399 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5601
Mailing Address - Country:US
Mailing Address - Phone:619-297-4433
Mailing Address - Fax:619-297-9247
Practice Address - Street 1:3399 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5601
Practice Address - Country:US
Practice Address - Phone:619-297-4433
Practice Address - Fax:619-297-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30357261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C303570Medicaid
CAA34231Medicare UPIN