Provider Demographics
NPI:1336230366
Name:VENER, JEROME D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:D
Last Name:VENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7345 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1929
Mailing Address - Country:US
Mailing Address - Phone:818-888-7878
Mailing Address - Fax:818-888-5200
Practice Address - Street 1:7345 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 510
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1929
Practice Address - Country:US
Practice Address - Phone:818-888-7878
Practice Address - Fax:818-888-5200
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36869207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46843Medicare UPIN
CAG36869Medicare ID - Type Unspecified