Provider Demographics
NPI:1588262174
Name:VENTURA STROMBERG, CANDY MILAGROS
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:MILAGROS
Last Name:VENTURA STROMBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRANDYWINE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5501
Mailing Address - Country:US
Mailing Address - Phone:575-779-6443
Mailing Address - Fax:
Practice Address - Street 1:1210 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6606
Practice Address - Country:US
Practice Address - Phone:501-574-3053
Practice Address - Fax:833-645-0881
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician