Basic Information
Provider Information
NPI: 1235447426
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARTELLO
FirstName: DOUGLAS
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: RRT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 ASPEN CIR
Address2:  
City: OXNARD
State: CA
PostalCode: 930304778
CountryCode: US
TelephoneNumber: 8052530125
FaxNumber:  
Practice Location
Address1: 2975 SYCAMORE DR
Address2:  
City: SIMI VALLEY
State: CA
PostalCode: 930651201
CountryCode: US
TelephoneNumber: 8054984344
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2010
LastUpdateDate: 09/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2279P3900XRCP10332CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics

No ID Information.


Home