Provider Demographics
NPI:1851326722
Name:RUIZ-MOLLESTON, JOY P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:P
Last Name:RUIZ-MOLLESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 80TH AVENUE CT W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3974
Mailing Address - Country:US
Mailing Address - Phone:253-565-6576
Mailing Address - Fax:253-474-5507
Practice Address - Street 1:7424 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 301
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8120
Practice Address - Country:US
Practice Address - Phone:253-474-5141
Practice Address - Fax:253-474-5507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024942207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1084425Medicaid
WARU5122OtherREGENCE
WAG8804263Medicare ID - Type Unspecified
F36271Medicare UPIN