Provider Demographics
NPI:1184205007
Name:VALDERRAMA, CARMENZA MARCELLA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMENZA
Middle Name:MARCELLA
Last Name:VALDERRAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1202 BROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501
Mailing Address - Country:US
Mailing Address - Phone:228-822-9360
Mailing Address - Fax:228-822-9361
Practice Address - Street 1:1202 BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-822-9360
Practice Address - Fax:228-822-9361
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS33795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine