Active NPI
Travis McLain Valderrama, RMA, CCHT-A
- Renal Dialysis Technician
- Savannah, GA
National Provider Identifier
1629456082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Renal Dialysis Technician
- Practice address
- 1460 E Victory Dr
Savannah, GA 31404-4108 - Phone
- (912) 412-0707
- NPI assigned
- May 18, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Renal Dialysis Technician | 2472R0900X | 00022495 | CA | |
| Renal Dialysis Technician | 2472R0900X | GA | Primary |
Addresses
Primary practice location
1460 E Victory Dr
Savannah, GA 31404-4108
Mailing address
3011 Ceres Ave Ste 125
Chico, CA 95973-5636
Phone (530) 343-5279
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06673 | Other | OR | OREGON HEALTH AUTHORITY CHT |
| 041388 | Other | NM | CERTIFIED HEMODIALYSIS TECHNICIAN |
| CHT 00022495 | Other | CA | CA DEPARTMENT OF PUBLIC HEALTH |
| HT60672991 | Other | WA | WA STATE DEPARTMENT OF HEALTH MAHT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Medical Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00022495 | CA | MD | Renal Dialysis Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545523200000",
"number": "1629456082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3011 CERES AVE STE 125",
"city": "CHICO",
"state": "CA",
"postal_code": "959735636",
"telephone_number": "530-343-5279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1460 E VICTORY DR",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314044108",
"telephone_number": "912-412-0707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALDERRAMA",
"first_name": "TRAVIS",
"middle_name": "MCLAIN",
"name_prefix": "Mr.",
"credential": "RMA, CCHT-A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-18",
"last_updated": "2018-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "2472R0900X",
"taxonomy_group": "",
"desc": "Technician, Other, Renal Dialysis",
"state": "CA",
"license": "00022495",
"primary": false
},
{
"code": "2472R0900X",
"taxonomy_group": "",
"desc": "Technician, Other, Renal Dialysis",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON HEALTH AUTHORITY CHT",
"identifier": "06673",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED HEMODIALYSIS TECHNICIAN",
"identifier": "041388",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA DEPARTMENT OF PUBLIC HEALTH",
"identifier": "CHT 00022495",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA STATE DEPARTMENT OF HEALTH MAHT",
"identifier": "HT60672991",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.