Provider Demographics
NPI:1437949542
Name:RANCHES, ANGELO JASON VALDERAMA (PT)
Entity type:Individual
Prefix:
First Name:ANGELO JASON
Middle Name:VALDERAMA
Last Name:RANCHES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 VAN NUYS BLVD APT 409
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5010
Mailing Address - Country:US
Mailing Address - Phone:818-217-6233
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD STE 242
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3593
Practice Address - Country:US
Practice Address - Phone:877-757-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist