Provider Demographics
NPI:1588939672
Name:VERTUCCI, MICHELE (PA-C/NP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:VERTUCCI
Suffix:
Gender:F
Credentials:PA-C/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2702
Mailing Address - Country:US
Mailing Address - Phone:323-461-3106
Mailing Address - Fax:323-461-3109
Practice Address - Street 1:910 VINE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2702
Practice Address - Country:US
Practice Address - Phone:323-461-3106
Practice Address - Fax:323-461-3109
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11454363A00000X
CA308876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner