Healthcare Provider Details

I. General information

NPI: 1306226360
Provider Name (Legal Business Name): KENILIA VENTURA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MILITARY TRL STE 218
JUPITER FL
33458-4831
US

IV. Provider business mailing address

4600 MILITARY TRL STE 218
JUPITER FL
33458-4831
US

V. Phone/Fax

Practice location:
  • Phone: 561-626-9041
  • Fax: 561-626-9634
Mailing address:
  • Phone: 561-626-9041
  • Fax: 561-626-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA09935600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME140657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: