Provider Demographics
NPI:1366491391
Name:VENTURA, EMERITO SR (MD)
Entity Type:Individual
Prefix:MR
First Name:EMERITO
Middle Name:
Last Name:VENTURA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CALLE VERBENA
Mailing Address - Street 2:CIUDAD JARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:G21 CALLE 10
Practice Address - Street 2:URB VILLA MATILDE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-6902
Practice Address - Country:US
Practice Address - Phone:787-870-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5109208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D83309Medicare UPIN
PR26679VEMedicare ID - Type Unspecified