Healthcare Provider Details

I. General information

NPI: 1770024739
Provider Name (Legal Business Name): MAURICIO A VENTURA BOCO, COA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 TREMONT ST BIEWEND BUILDING, LEVEL B
BOSTON MA
02116-5603
US

IV. Provider business mailing address

260 TREMONT STREET BIEWEND BUILDING, LEVEL B
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 617-695-0101
  • Fax: 617-695-0222
Mailing address:
  • Phone: 617-695-0101
  • Fax: 617-695-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: