Healthcare Provider Details

I. General information

NPI: 1134166580
Provider Name (Legal Business Name): VENTRIMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 RAVEN LN
ALISO VIEJO CA
92656-1886
US

IV. Provider business mailing address

53 RAVEN LN
ALISO VIEJO CA
92656-1886
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-7955
  • Fax: 949-705-6518
Mailing address:
  • Phone: 949-855-7955
  • Fax: 949-705-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA BRINKER
Title or Position: PRESIDENT
Credential: CCT
Phone: 949-855-7955