Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | A34154 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | A34154 | CA |
NPI | 1306868328 |
---|---|
Provider Name | Mr. Randal John Vecchione |
First Address | San Diego, CA 92103-6537 |
Second Address | San Diego, CA 92103-6537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A341540 | (05) | CA |
A27395 | (02) |