Healthcare Provider Details

I. General information

NPI: 1730499989
Provider Name (Legal Business Name): JENNY VENTURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

IV. Provider business mailing address

1210 PERALTA AVE
BERKELEY CA
94706-2406
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-1222
  • Fax:
Mailing address:
  • Phone: 415-260-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: