Provider Demographics
NPI:1992839906
Name:JOY P. RUIZ-MOLLESTON, M.D., PS
Entity Type:Organization
Organization Name:JOY P. RUIZ-MOLLESTON, M.D., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-895-1521
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 STE 301
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8135
Practice Address - Country:US
Practice Address - Phone:253-474-5141
Practice Address - Fax:253-474-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024942207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1084425Medicaid
WA0039287OtherL&I
WARU5122OtherREGENCE
WAG8804263Medicare ID - Type UnspecifiedMEDICARE