Provider Demographics
NPI:1225789787
Name:VENTURA, MARISOL MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:MARIE
Last Name:VENTURA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 E 76TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2822
Mailing Address - Country:US
Mailing Address - Phone:212-434-2323
Mailing Address - Fax:
Practice Address - Street 1:186 E 76TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2822
Practice Address - Country:US
Practice Address - Phone:212-434-2323
Practice Address - Fax:212-434-6885
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03189401207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty