Provider Demographics
NPI:1801100326
Name:VENTURA, DIANE (MS)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:VENTURA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 ALOMA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3340
Mailing Address - Country:US
Mailing Address - Phone:407-629-0413
Mailing Address - Fax:407-629-2603
Practice Address - Street 1:4386 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-7031
Practice Address - Country:US
Practice Address - Phone:407-760-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 7517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH 7517OtherSTATE LICENSE NUMBER