Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3211 | CA |
Y | 222Z00000X | Podiatrist | E3211 | CA |
NPI | 1003813783 |
---|---|
Provider Name | Dr. Donald Triolo |
First Address | San Diego, CA 92120-5253 |
Second Address | San Diego, CA 92120-5253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 15/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E3211 | (05) | CA |
480003710 | RAILROAD MEDICARE (01) | CA |
AT2684264 | REA (01) | |
E3211 | STATE LICENSE (01) | |
T19282 | (02) |