Provider Demographics
NPI:1528618634
Name:VENTURA, JORGE MARCOS (MS, BCBA)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:MARCOS
Last Name:VENTURA
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 OREGON AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5267
Mailing Address - Country:US
Mailing Address - Phone:310-462-2897
Mailing Address - Fax:
Practice Address - Street 1:3745 LONG BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3340
Practice Address - Country:US
Practice Address - Phone:310-787-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-52103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst