Healthcare Provider Details

I. General information

NPI: 1629763008
Provider Name (Legal Business Name): VENTURA HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 NW 79TH AVE APT 107
DORAL FL
33166-5418
US

IV. Provider business mailing address

4810 NW 79TH AVE APT 107
DORAL FL
33166-5418
US

V. Phone/Fax

Practice location:
  • Phone: 786-626-4081
  • Fax:
Mailing address:
  • Phone: 786-626-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VENTURA SILVERIO SOLIS
Title or Position: MANAGER
Credential: APRN11024206
Phone: 786-626-4081