Healthcare Provider Details

I. General information

NPI: 1366284820
Provider Name (Legal Business Name): RUQIAN MA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 114TH AVE SE STE 222
BELLEVUE WA
98004-6905
US

IV. Provider business mailing address

24033 SE 12TH PL
SAMMAMISH WA
98075-8151
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-5788
  • Fax:
Mailing address:
  • Phone: 617-515-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY61599435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: