MEDICARE: PATRICIO DEJALDE VIRATA II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1043025349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIO DEJALDE VIRATA II

Provider Business Mailing Address
First Line	:	748 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5183
Country	:	US
Telephone Number	:	402-595-0231
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 N CHRISTY ST
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-3771
Country	:	US
Telephone Number	:	402-595-0231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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