Provider Demographics
NPI:1770024739
Name:VENTURA, MAURICIO A (BOCO, COA)
Entity Type:Individual
Prefix:MR
First Name:MAURICIO
Middle Name:A
Last Name:VENTURA
Suffix:
Gender:M
Credentials:BOCO, COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 TREMONT STREET
Mailing Address - Street 2:BIEWEND BUILDING, LEVEL B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-695-0101
Mailing Address - Fax:617-695-0222
Practice Address - Street 1:260 TREMONT ST
Practice Address - Street 2:BIEWEND BUILDING, LEVEL B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5603
Practice Address - Country:US
Practice Address - Phone:617-695-0101
Practice Address - Fax:617-695-0222
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist