Provider Demographics
NPI:1770898710
Name:RUELAS, ADRIAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:RUELAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 DEL PASO BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3102
Mailing Address - Country:US
Mailing Address - Phone:916-924-7988
Mailing Address - Fax:916-924-7989
Practice Address - Street 1:2200 DEL PASO BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3102
Practice Address - Country:US
Practice Address - Phone:916-924-7988
Practice Address - Fax:916-924-7989
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical