Provider Demographics
NPI:1447391578
Name:VENTURA, MIGUEL J
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:J
Last Name:VENTURA
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 1:1168 CALLE LUIS NEC
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2421
Mailing Address - Country:US
Mailing Address - Phone:787-769-9117
Mailing Address - Fax:
Practice Address - Street 1:851 CALLE LAFAYETTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2627
Practice Address - Country:US
Practice Address - Phone:787-724-3307
Practice Address - Fax:787-721-4165
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2609183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician