Individual
FERNANDO RENGIFO-CAICEDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP007041
Contact information
Practice address
856 RED HART LN, ALPHARETTA, GA 30004-4142
(202) 297-5314
Mailing address
856 RED HART LN, ALPHARETTA, GA 30004-4142
(202) 297-5314
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1331465
DRIVER'S LICENSE
WA
Enumeration date
03/18/2009
Last updated
01/29/2010
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