Individual
ROBERT LOUIS VENTULETT
Active
Individual
ROBERT LOUIS VENTULETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1680
SC
363AM0700X
Medical Physician Assistant
Primary
2933
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1236PA
—
SC
01
—
1680
STATE LICENSE
SC
Enumeration date
08/30/2011
Last updated
07/10/2013
Update your record
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