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General NPI Number Information
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NPI Number | 1588939672
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Entity Type | Individual
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Provider Name | MICHELE VERTUCCI PA-C/NP
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Gender | Female
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 910 VINE ST
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City | LOS ANGELES
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State | CA
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Zip | 90038-2702
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Country | US
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Telephone | 323-461-3106
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Fax | 323-461-3109
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Provider Business Mailing Address
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Address Line | 910 VINE ST
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City | LOS ANGELES
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State | CA
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Zip | 90038-2702
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Country | US
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Telephone | 323-461-3106
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Fax | 323-461-3109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11454
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 308876
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License Number State | CA
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