Ruth Wauqua Bol, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

51668 Issued in CA

Practice address

4004 Beyer Blvd
San Ysidro, CA 92173-2099

Phone

(619) 662-4100

NPI assigned

Apr 23, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rbol54841@syhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1366053167
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1124246376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732099",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6509 Highway 41A",
            "address_purpose": "LOCATION",
            "city": "Pleasant View",
            "state": "TN",
            "postal_code": "371467170",
            "country_code": "US",
            "telephone_number": "615-247-7100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1005 Dr Db Todd Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372083501",
            "country_code": "US",
            "telephone_number": "615-327-6000",
            "fax_number": "615-327-5597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOL",
        "first_name": "RUTH",
        "middle_name": "WAUQUA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00009723",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "10407",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "51668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q026775",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.mmc.edu",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1005 Dr Db Todd Jr Blvd",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372083501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alma Barraza Meza
• Wilbur Adrian Diente Barsana
• Vanessa Bastidas, MD, MPH
• Rita L Bederman
• Justin Michael Bennink, M.D.
• Natasha Estelle Brambila-Braga, DDS
• Andrew M Bui
• Kelley Alexis Butler, MD, MPH
• Roxanna Calvario, PA
• Jocelin Camacho

• Pediatric Dentistry in San Ysidro, CA
• Providers in San Ysidro, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.