Healthcare Provider Details

I. General information

NPI: 1063814358
Provider Name (Legal Business Name): JASON VALDERRAMA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 E EXPOSITION AVE
AURORA CO
80012-2542
US

IV. Provider business mailing address

12439 E HARVARD DR
AURORA CO
80014-1923
US

V. Phone/Fax

Practice location:
  • Phone: 720-853-4230
  • Fax: 303-745-4832
Mailing address:
  • Phone: 970-217-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4125
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: