MEDICARE: MICHAEL PAUL VITULLO D.O.

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	20A4549	CA

General Provider Information

NPI Number	:	1912111659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PAUL VITULLO D.O.

Provider Business Mailing Address
First Line	:	22848 OXNARD ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3227
Country	:	US
Telephone Number	:
Fax Number	:	818-340-6212

Provider Business Practice Location Address
First Line	:	22848 OXNARD ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3227
Country	:	US
Telephone Number	:	818-340-6118
Fax Number	:	818-340-6212

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	03/02/2010

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