Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME87582 | FL |
N | 111NI0900X | Internist | ME87582 | FL |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD431957 | PA |
NPI | 1023002037 |
---|---|
Provider Name | Dr. Jose Vicente Venero |
First Address | Washington, PA 15301-5892 |
Second Address | Washington, PA 15301-5892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 16/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
268238900 | (05) | FL |
71003 | BCBS (01) | FL |
H86534 | (02) |