MEDICARE: RALPH J. VENUTO, MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	G15060	CA

General Provider Information

NPI Number	:	1174895221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALPH J. VENUTO, MD, INC.

Provider Business Mailing Address
First Line	:	360 SAN MIGUEL DR STE 701
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5927
Country	:	US
Telephone Number	:	949-759-3600
Fax Number	:	949-759-0282

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 701
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5927
Country	:	US
Telephone Number	:	949-759-3600
Fax Number	:	949-759-0282

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KAREN KAWADA
Credential	:
Telephone Number	:	949-270-0344

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	02/06/2012

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