MEDICARE: JESSE ALEXANDER VENTURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	V536421032090	FL

General Provider Information

NPI Number	:	1497572309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE ALEXANDER VENTURA

Provider Business Mailing Address
First Line	:	3200 N 66TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2930
Country	:	US
Telephone Number	:	954-947-9782
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N 66TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2930
Country	:	US
Telephone Number	:	954-947-9782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/25/2024

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Directions to “ JESSE ALEXANDER VENTURA ” Practice Location

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