Provider Demographics
NPI:1285880831
Name:AICHROTH, DONALD WILLIAM (SF IDC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WILLIAM
Last Name:AICHROTH
Suffix:
Gender:M
Credentials:SF IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 2496, BAUER ROAD
Mailing Address - Street 2:BMC MIRAMAR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92145-2002
Mailing Address - Country:US
Mailing Address - Phone:858-577-9849
Mailing Address - Fax:858-577-9965
Practice Address - Street 1:BLDG 2496, BAUER ROAD
Practice Address - Street 2:BMC MIRAMAR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-2002
Practice Address - Country:US
Practice Address - Phone:858-577-9849
Practice Address - Fax:858-577-9965
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman