Provider Demographics
NPI:1801956180
Name:VENTURA, CESAR ANTONIO
Entity type:Individual
Prefix:MR
First Name:CESAR
Middle Name:ANTONIO
Last Name:VENTURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 PONA WAY
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1728
Mailing Address - Country:US
Mailing Address - Phone:808-871-0779
Mailing Address - Fax:808-877-3130
Practice Address - Street 1:708 PONA WAY
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1728
Practice Address - Country:US
Practice Address - Phone:808-871-0779
Practice Address - Fax:808-877-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020410307376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56009601Medicaid