Provider Demographics
NPI:1194027185
Name:VENTURA, RAUL (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:VENTURA
Suffix:
Gender:M
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5418
Mailing Address - Country:US
Mailing Address - Phone:786-229-6636
Mailing Address - Fax:786-206-3178
Practice Address - Street 1:15411 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5418
Practice Address - Country:US
Practice Address - Phone:786-229-6636
Practice Address - Fax:786-206-3178
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11004925OtherHMO
FL11004925Medicaid