Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | C30357 | CA |
NPI | 1154415891 |
---|---|
Provider Name | Thomas R. Vecchione |
First Address | San Diego, CA 92103 |
Second Address | San Diego, CA 92103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 24/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C303570 | (05) | CA |
A34231 | (02) | CA |