Healthcare Provider Details

I. General information

NPI: 1740416874
Provider Name (Legal Business Name): DANIELE ANDREE VECCHIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 LAGO LINDO
RANCHO SANT FE CA
92067
US

IV. Provider business mailing address

P.O. BOX 199
RANCHO SANT FE CA
92067
US

V. Phone/Fax

Practice location:
  • Phone: 858-756-1733
  • Fax:
Mailing address:
  • Phone: 858-756-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG25755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: