Provider Demographics
NPI:1912111659
Name:VITULLO, MICHAEL PAUL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:VITULLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22848 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-340-6212
Practice Address - Street 1:22848 OXNARD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3227
Practice Address - Country:US
Practice Address - Phone:818-340-6118
Practice Address - Fax:818-340-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4549207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services