Healthcare Provider Details

I. General information

NPI: 1336230366
Provider Name (Legal Business Name): JEROME D VENER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 MEDICAL CENTER DRIVE SUITE 510
WEST HILLS CA
91307-1929
US

IV. Provider business mailing address

7345 MEDICAL CENTER DRIVE SUITE 510
WEST HILLS CA
91307-1929
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-7878
  • Fax: 818-888-5200
Mailing address:
  • Phone: 818-888-7878
  • Fax: 818-888-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG36869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: