Provider Demographics
NPI:1720479439
Name:VENTURA ELLIS, INGRID
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:
Last Name:VENTURA ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:YOMARA
Other - Last Name:VENTURA ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11514 GOODLOE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4838
Mailing Address - Country:US
Mailing Address - Phone:301-942-7288
Mailing Address - Fax:
Practice Address - Street 1:11514 GOODLOE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4838
Practice Address - Country:US
Practice Address - Phone:301-942-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator