Provider Demographics
NPI:1609515444
Name:VALDERRAMA, BERNABE
Entity Type:Individual
Prefix:
First Name:BERNABE
Middle Name:
Last Name:VALDERRAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 E PACIFIC COAST HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6929
Mailing Address - Country:US
Mailing Address - Phone:562-579-6421
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST HWY STE 310
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6929
Practice Address - Country:US
Practice Address - Phone:562-579-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator