Provider Demographics
NPI:1831367465
Name:VENA, VIRGINIO (DPM)
Entity type:Individual
Prefix:MR
First Name:VIRGINIO
Middle Name:
Last Name:VENA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W INDIANTOWN RD STE K
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7557
Mailing Address - Country:US
Mailing Address - Phone:561-741-4900
Mailing Address - Fax:561-741-4918
Practice Address - Street 1:651 W INDIANTOWN RD STE K
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7557
Practice Address - Country:US
Practice Address - Phone:561-741-4900
Practice Address - Fax:561-741-4918
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2828213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU84408Medicare UPIN
FLE5305ZMedicare PIN