Provider Demographics
NPI:1205998366
Name:VENTURA, JUANCHICHOS T (MD)
Entity type:Individual
Prefix:
First Name:JUANCHICHOS
Middle Name:T
Last Name:VENTURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-1510
Mailing Address - Country:US
Mailing Address - Phone:775-945-2461
Mailing Address - Fax:775-945-2359
Practice Address - Street 1:1ST AND A ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-1510
Practice Address - Country:US
Practice Address - Phone:775-945-2461
Practice Address - Fax:775-945-2359
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12049OtherNEVADA LICENSE
NVG80993Medicare UPIN
NVV102929Medicare PIN