Healthcare Provider Details

I. General information

NPI: 1750264255
Provider Name (Legal Business Name): ERASMO RUIZ GONZALEZ M.ED, MHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21120 MERIDIAN E
GRAHAM WA
98338-8254
US

IV. Provider business mailing address

18610 16TH AVENUE CT E
SPANAWAY WA
98387-1904
US

V. Phone/Fax

Practice location:
  • Phone: 253-285-4750
  • Fax:
Mailing address:
  • Phone: 541-645-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: