MEDICARE: VERNON R PERTELLE RRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	164X00000X	Licensed Vocational Nurse	VN144365	CA
3	174H00000X	Health Educator
4	227900000X	Registered Respiratory Therapist	RCP15962	CA
5	227900000X	Registered Respiratory Therapist
6	2279H0200X	Home Health Registered Respiratory Therapist	RCP15962	CA
7	2279H0200X	Home Health Registered Respiratory Therapist
8	2279E1000X	Educational Registered Respiratory Therapist	RCP15962	CA

General Provider Information

NPI Number	:	1700375904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNON R PERTELLE RRT

Provider Business Mailing Address
First Line	:	8605 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-4109
Country	:	US
Telephone Number	:	760-473-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 MESCALITA CT
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-7953
Country	:	US
Telephone Number	:	760-473-0368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	09/24/2023

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Directions to “ VERNON R PERTELLE RRT” Practice Location

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