1063598191 NPI number — FLORA ANN VENTURA CNA

Table of content: FLORA ANN VENTURA CNA (NPI 1063598191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063598191 NPI number — FLORA ANN VENTURA CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VENTURA
Provider First Name:
FLORA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063598191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7900 S J STOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85746-7012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-295-2503
Provider Business Mailing Address Fax Number:
520-295-2676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 86 AND TOPAWA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELLS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-383-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)