Healthcare Provider Details

I. General information

NPI: 1902173644
Provider Name (Legal Business Name): MANUEL ALEJANDRO VALDERRAMA OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 SW 106TH AVE STE 110
CUTLER BAY FL
33157-7670
US

IV. Provider business mailing address

7213 ELITE CT
LAS VEGAS NV
89129-5988
US

V. Phone/Fax

Practice location:
  • Phone: 305-233-4448
  • Fax:
Mailing address:
  • Phone: 786-419-7379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT-2567
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: