Individual
EDWIN G VENTOCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6339 MACK RD, SACRAMENTO, CA 95823-4655
(916) 454-2345
Mailing address
1860 HOWE AVE STE 440, SACRAMENTO, CA 95825-1098
(916) 569-8484
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16349
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DV5277-P01505494
RAILROAD MEDICARE
CA
05
—
EFF 6/18/15
—
CA
Enumeration date
12/02/2006
Last updated
01/06/2023
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