Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95001814 | CA |
NPI | 1043676067 |
---|---|
Provider Name | Cristina Ventura |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2016 |
Last Update Date | 19/12/2019 |