Individual
KENDRICK RUELO DE CASTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
400 TOWER RD NE STE 200, MARIETTA, GA 30060-9412
(770) 422-1372
Mailing address
1845 PIEDMONT AVE NE APT 522, ATLANTA, GA 30324-5170
(404) 861-1549
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12626
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/23/2024
Last updated
10/21/2024
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