Provider Demographics
NPI:1760951289
Name:VENTURA, LUIS III
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:VENTURA
Suffix:III
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 1:210 PRAIRIE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2816
Mailing Address - Country:US
Mailing Address - Phone:972-754-6317
Mailing Address - Fax:
Practice Address - Street 1:210 PRAIRIE VIEW LN
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2816
Practice Address - Country:US
Practice Address - Phone:972-754-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339086164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse