Healthcare Provider Details

I. General information

NPI: 1104353770
Provider Name (Legal Business Name): VENTURE MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 E PIMA ST
TUCSON AZ
85712-5611
US

IV. Provider business mailing address

12410 E CAMINO DEL GARANON
TUCSON AZ
85747-9729
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-5515
  • Fax:
Mailing address:
  • Phone: 520-278-8825
  • Fax: 520-350-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAP4757
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberAP4757
License Number StateAZ

VIII. Authorized Official

Name: MRS. JACQUELINE LEWIS RAMIREZ
Title or Position: MANAGING MEMBER
Credential: FNP-C
Phone: 520-278-8825