Healthcare Provider Details

I. General information

NPI: 1730225293
Provider Name (Legal Business Name): JAMES THOMAS VENTRESCA D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 4TH ST NW
ALBUQUERQUE NM
87107-6642
US

IV. Provider business mailing address

PO BOX 1291
TIJERAS NM
87059-1291
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-5928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number372
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: