Provider Demographics
NPI:1073290375
Name:VENTURA RIVERA, ULISES
Entity Type:Individual
Prefix:
First Name:ULISES
Middle Name:
Last Name:VENTURA RIVERA
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 1:345 W VINEYARD AVE APT 599
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2068
Mailing Address - Country:US
Mailing Address - Phone:503-800-1190
Mailing Address - Fax:
Practice Address - Street 1:5740 RALSTON ST STE 201
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6571
Practice Address - Country:US
Practice Address - Phone:805-289-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker