MEDICARE: ROXANA DE JESUS VENTIRA

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1619312402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANA DE JESUS VENTIRA

Provider Business Mailing Address
First Line	:	4310 JEFFERSON ST APT 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1920
Country	:	US
Telephone Number	:	240-425-2109
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 JEFFERSON ST APT 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1920
Country	:	US
Telephone Number	:	240-425-2109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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Directions to “ ROXANA DE JESUS VENTIRA ” Practice Location

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