Provider Demographics
NPI:1750675450
Name:VENTURA, RAFAEL RENE III
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:RENE
Last Name:VENTURA
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RAFAEL
Other - Middle Name:RENE
Other - Last Name:VENTURA
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:BSW, MPA
Mailing Address - Street 1:1119 WINIFRED AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5559
Mailing Address - Country:US
Mailing Address - Phone:626-405-1544
Mailing Address - Fax:
Practice Address - Street 1:11927 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3740
Practice Address - Country:US
Practice Address - Phone:626-350-5304
Practice Address - Fax:626-350-0756
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health