Provider Demographics
NPI:1497972962
Name:VENTURA, MARIA DE LOURDES
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LOURDES
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:PMB 48 PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2500
Mailing Address - Country:US
Mailing Address - Phone:787-763-8435
Mailing Address - Fax:787-764-6492
Practice Address - Street 1:601 CALLE LODI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3844
Practice Address - Country:US
Practice Address - Phone:787-763-8435
Practice Address - Fax:787-764-6492
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30735OtherSSS
PR30735OtherSSS