Individual
MARK RYAN VENTURA DOMINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
33608 ORTEGA HWY SAN JUAN CAPISTRANO, SAN JUAN CAPISTRANO, CA 92675
(800) 642-4657
Mailing address
70 SKLAR ST APT 603, LADERA RANCH, CA 92694-0766
(949) 615-8407
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
MTA-02245121
CA
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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