Provider Demographics
NPI:1629456082
Name:VALDERRAMA, TRAVIS MCLAIN (RMA, CCHT-A)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:MCLAIN
Last Name:VALDERRAMA
Suffix:
Gender:M
Credentials:RMA, CCHT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 CERES AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5636
Mailing Address - Country:US
Mailing Address - Phone:530-343-5279
Mailing Address - Fax:
Practice Address - Street 1:1460 E VICTORY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-4108
Practice Address - Country:US
Practice Address - Phone:912-412-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000224952472R0900X
GA2472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR06673OtherOREGON HEALTH AUTHORITY CHT
NM041388OtherCERTIFIED HEMODIALYSIS TECHNICIAN
CACHT 00022495OtherCA DEPARTMENT OF PUBLIC HEALTH
WAHT60672991OtherWA STATE DEPARTMENT OF HEALTH MAHT