Individual
MARIELA CELESTE VENTOCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1145 STURGIS ROAD, TWENTYNINE PALMS, CA 92277
(916) 734-2356
Mailing address
3101 UPSHUR AVE APT C, TWENTYNINE PALMS, CA 92277-9482
(408) 458-0132
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207QA0505X
Adult Medicine Physician
Primary
010127041
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010127041
LISCENCE NUMBER
VA
Enumeration date
03/31/2013
Last updated
09/23/2022
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