Healthcare Provider Details

I. General information

NPI: 1932715430
Provider Name (Legal Business Name): CHRISTIAN ANGELO VENTURA RP, NRAEMT, EMT-INST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2020
Last Update Date: 05/14/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 VT 110
CHELSEA VT
05038
US

IV. Provider business mailing address

279 VT 110
TUNBRIDGE VT
05077-9578
US

V. Phone/Fax

Practice location:
  • Phone: 732-372-2141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number097.0134992
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number097.0134992
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number105065
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number097.0134992
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number105065
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: