Basic Information
Provider Information
NPI: 1669848396
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VENTURA
FirstName: JOSEPH
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3261 S URAVAN CT
Address2:  
City: AURORA
State: CO
PostalCode: 800134424
CountryCode: US
TelephoneNumber: 3039939892
FaxNumber:  
Practice Location
Address1: 1333 IRIS AVE
Address2:  
City: BOULDER
State: CO
PostalCode: 803042226
CountryCode: US
TelephoneNumber: 3034136212
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2015
LastUpdateDate: 08/17/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X0104580COY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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