Provider Demographics
NPI:1275143679
Name:VENTURA, INGRID
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:
Last Name:VENTURA
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 1:1382 SHAKESPEARE AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-1878
Mailing Address - Country:US
Mailing Address - Phone:646-784-5061
Mailing Address - Fax:
Practice Address - Street 1:1382 SHAKESPEARE AVE APT 5C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1878
Practice Address - Country:US
Practice Address - Phone:646-784-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker