Provider Demographics
NPI:1316947393
Name:VENTURA, VERONICA L (MD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:L
Last Name:VENTURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:STE 104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4250
Mailing Address - Country:US
Mailing Address - Phone:253-272-5572
Mailing Address - Fax:253-272-5699
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:STE 104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4250
Practice Address - Country:US
Practice Address - Phone:253-272-5572
Practice Address - Fax:253-272-5699
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH92274Medicare UPIN
WAAB38825Medicare ID - Type Unspecified