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General NPI Number Information
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NPI Number | 1396127742
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Entity Type | Individual
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Provider Name | KATRINA VENTURA-MORANO M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 155 CALLE PORTAL STE 300
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-459-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 F AVE
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City | DOUGLAS
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State | AZ
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Zip | 85607-1920
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Country | US
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Telephone | 520-364-6852
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Fax | 520-364-4261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 00128440
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 55014
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License Number State | AZ
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