Provider Demographics
NPI:1629298005
Name:NATIVIDAD, VENTURA (DC)
Entity Type:Individual
Prefix:DR
First Name:VENTURA
Middle Name:
Last Name:NATIVIDAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 FELSPAR ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2826
Mailing Address - Country:US
Mailing Address - Phone:619-277-2104
Mailing Address - Fax:858-750-6807
Practice Address - Street 1:1052 FELSPAR ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2826
Practice Address - Country:US
Practice Address - Phone:619-277-2104
Practice Address - Fax:858-750-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor