Provider Demographics
NPI:1669548194
Name:FRUTO, JEAN VENTURANZA (MSN FNP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:VENTURANZA
Last Name:FRUTO
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 COLORADO AVE #103
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-453-0031
Mailing Address - Fax:
Practice Address - Street 1:7045 VAN NUYS BLVD
Practice Address - Street 2:OLMC UCLA MID VALLEY COMPREHENSIVE HEALTH CENTER
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:310-947-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q06383Medicare UPIN
Q06383Medicare ID - Type Unspecified