Italian Police Chief Antonio Manganelli said the 6.3-magnitude quake that struck in the pre-dawn hours left "a horrible scene of death and destruction," Italian news agency ANSA reported.
Officials said they expected the death toll would continue to rise. More than 1,500 people were injured and 70,000 were left homeless from Italy's biggest quake in nearly 30 years, the news agency said.
Roughly 4,000 rescue workers were at the site and Italy will be able to access the European Union's disaster fund, said Italian Prime Minister Silvio Berlusconi who canceled a trip to Moscow to be at the scene in Italy's rugged mountain region about 60 miles northeast of Rome.
The earthquake was Italy's worst since 2,570 people were killed southeast of Naples in 1980.
Berlusconi said a tent city with 2,000 tents that can house 8-10 people was being set up for people left homeless. Interior Minister Roberto Maroni said some of the homeless would be put up in hotels as well.
"The fundamental thing I want to say is that nobody will be left alone," Berlusconi said.
U.S. missionary Joshua Brothers told CNN the damage in L'Aquila was in the city's center.
"Most of the buildings in the city center are more than a 100 years old and so they have walls that are a lot weaker than other palazzi that are made of reinforced concrete," Brothers said.
Tremors from the quake were felt as far away as Rome, where people reported being awakened as buildings shook.