Provider Demographics
NPI:1275284168
Name:VENTOCILLA, ANGELITA
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:
Last Name:VENTOCILLA
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 1:10850 BARDEN DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8001
Mailing Address - Country:US
Mailing Address - Phone:916-595-8844
Mailing Address - Fax:
Practice Address - Street 1:4378 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4175
Practice Address - Country:US
Practice Address - Phone:279-348-7200
Practice Address - Fax:279-348-7201
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757882163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse