NPIMap

Organization Active NPI

Rafael Medicus Clinic, Corp.

  • Family Medicine Physician
  • Lakewood, WA
National Provider Identifier
1558718684
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00024942 Issued in WA
Legal business name
RAFAEL MEDICUS CLINIC, CORP.
Practice address
7424 Bridgeport Way West
Suite 301
Lakewood, WA 98499-8135
Phone
(253) 474-5141
Fax
(253) 474-5507
NPI assigned
May 18, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Authorized official

Name
Mr. Glenn Noel Padilla Ruiz
Title
President
Phone
(253) 474-5141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MD00024942 WA Primary

Addresses

Primary practice location

7424 Bridgeport Way West
Suite 301
Lakewood, WA 98499-8135

Mailing address

7424 Bridgeport Way West
Suite 301
Lakewood, WA 98499-8135
Phone (253) 474-5141

National Provider Directory

National Provider Directory

Locations

7424 Bridgeport Way W
Ste 301
Tacoma, WA 98499
Phone (253) 474-5141

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1558718684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7424 BRIDGEPORT WAY WEST",
            "address_2": "SUITE 301",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998135",
            "telephone_number": "253-474-5141",
            "fax_number": "253-474-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7424 BRIDGEPORT WAY WEST",
            "address_2": "SUITE 301",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998135",
            "telephone_number": "253-474-5141",
            "fax_number": "253-474-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAFAEL MEDICUS CLINIC, CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "GLENN NOEL",
        "authorized_official_middle_name": "PADILLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-474-5141",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00024942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.