Provider Demographics
NPI:1336905751
Name:VALDERRAMA RODRIGUEZ, GABRIEL JESUS
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JESUS
Last Name:VALDERRAMA RODRIGUEZ
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 1:2914 SE 15TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2347
Mailing Address - Country:US
Mailing Address - Phone:786-459-9328
Mailing Address - Fax:
Practice Address - Street 1:2914 SE 15TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2347
Practice Address - Country:US
Practice Address - Phone:786-459-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician