Healthcare Provider Details

I. General information

NPI: 1154415891
Provider Name (Legal Business Name): THOMAS R. VECCHIONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 FIRST AVENUE
SAN DIEGO CA
92103
US

IV. Provider business mailing address

3399 FIRST AVENUE
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-4433
  • Fax: 619-297-9247
Mailing address:
  • Phone: 619-297-4433
  • Fax: 619-297-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberC30357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: