Healthcare Provider Details

I. General information

NPI: 1386130284
Provider Name (Legal Business Name): SOFIA KAREN VENTURINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SANTA ANA BLVD
SANTA ANA CA
92701-4558
US

IV. Provider business mailing address

600 W SANTA ANA BLVD
SANTA ANA CA
92701-4558
US

V. Phone/Fax

Practice location:
  • Phone: 949-500-4519
  • Fax:
Mailing address:
  • Phone: 949-500-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: