Provider Demographics
NPI:1962430066
Name:VENITTELLI, GIOVANNI (OD)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:VENITTELLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31333 TEMECULA PKWY
Mailing Address - Street 2:SUITE#C10-140
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6831
Mailing Address - Country:US
Mailing Address - Phone:951-302-1331
Mailing Address - Fax:866-812-6094
Practice Address - Street 1:31333 TEMECULA PKWY
Practice Address - Street 2:SUITE#C10-140
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6831
Practice Address - Country:US
Practice Address - Phone:951-302-1331
Practice Address - Fax:866-812-6094
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8043T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U29040Medicare UPIN
CASD0080430Medicare PIN