Provider Demographics
NPI:1790146231
Name:RUIZ, BRITTANY NAOMI (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NAOMI
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:NAOMI
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2690 NE KRESKY AVE
Mailing Address - Street 2:CHEHALIS
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2412
Mailing Address - Country:US
Mailing Address - Phone:360-330-9595
Mailing Address - Fax:360-330-9560
Practice Address - Street 1:3775 MARTIN WAY E STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5007
Practice Address - Country:US
Practice Address - Phone:360-236-7166
Practice Address - Fax:360-529-8070
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60725219363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077227Medicaid