Provider Demographics
NPI:1962195685
Name:TOLENTINO VENTURA, JOSE ESTEBAN
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ESTEBAN
Last Name:TOLENTINO VENTURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 WEBSTER AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1851
Mailing Address - Country:US
Mailing Address - Phone:347-384-0051
Mailing Address - Fax:
Practice Address - Street 1:10450 102ND ST APT 2E
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2204
Practice Address - Country:US
Practice Address - Phone:929-354-1829
Practice Address - Fax:929-244-7394
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1534308211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty