Ventocilla, Mark Augusto
Ventocilla, Mark Augusto is an sole proprietor health care provider with primary practice located at 613 E Grand Ave , Escondido CA 92025-4402. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ventocilla, Mark Augusto can be contacted via phone (760) 747-4797.Contact Information
Primary practice address
613 E Grand Ave
Escondido CA 92025-4402
Phone: (760) 747-4797
Fax: (760) 747-7799
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4901003734 | Michigan |
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPC 3532 | Florida |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 10435 | California |
Profile Details
| NPI number | 1528158664 |
|---|---|
| LBN Legal business name | Ventocilla, Mark Augusto |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 12th, 2006 |
| Last updated | Mar 12th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528158664 | NPPES |
| Michigan | MEDICAID | 4454950 | |
| Michigan | MEDICAID | 4820570 | |
| Michigan | Other | 900F165350 | |
| Michigan | Other | 90G011590 |
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