Provider Demographics
NPI:1780260794
Name:JOY, RUBY VADAKKETHONDALIL (NP)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:VADAKKETHONDALIL
Last Name:JOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 QUIET LAKE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5581
Mailing Address - Country:US
Mailing Address - Phone:409-354-3324
Mailing Address - Fax:
Practice Address - Street 1:13209 QUIET LAKE LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5581
Practice Address - Country:US
Practice Address - Phone:409-354-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty