Provider Demographics
NPI:1548527666
Name:VENTURA, JOSE ALVINO (NMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALVINO
Last Name:VENTURA
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W GLENDALE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7694
Mailing Address - Country:US
Mailing Address - Phone:623-428-2578
Mailing Address - Fax:480-304-3265
Practice Address - Street 1:2301 W GLENDALE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7694
Practice Address - Country:US
Practice Address - Phone:623-428-2578
Practice Address - Fax:480-304-3265
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1294175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath