Healthcare Provider Details

I. General information

NPI: 1770898710
Provider Name (Legal Business Name): ADRIAN RUELAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2010
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DEL PASO BLVD
SACRAMENTO CA
95815-3102
US

IV. Provider business mailing address

2200 DEL PASO BLVD
SACRAMENTO CA
95815-3102
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-7988
  • Fax: 916-924-7989
Mailing address:
  • Phone: 916-924-7988
  • Fax: 916-924-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: