Provider Demographics
NPI:1750149142
Name:RUIZ DOMINGUEZ, MARISOL G
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:G
Last Name:RUIZ DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30607 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4002
Mailing Address - Country:US
Mailing Address - Phone:206-460-3748
Mailing Address - Fax:
Practice Address - Street 1:30607 2ND AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4002
Practice Address - Country:US
Practice Address - Phone:206-460-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula