Provider Demographics
NPI:1922343821
Name:VALDERRAMA, HERMAN JR
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:VALDERRAMA
Suffix:JR
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 1:6980 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6635
Mailing Address - Country:US
Mailing Address - Phone:408-776-6201
Mailing Address - Fax:408-778-9672
Practice Address - Street 1:6980 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6635
Practice Address - Country:US
Practice Address - Phone:408-776-6201
Practice Address - Fax:408-778-9672
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator