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General NPI Number Information
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NPI Number | 1538192976
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Entity Type | Individual
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Provider Name | ROSS MAGLAQUE REALICA MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
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City | TACOMA
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State | WA
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Zip | 98431
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Country | US
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Telephone | 253-441-0598
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Fax |
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Provider Business Mailing Address
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Address Line | 9722 55TH STREET CT W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-1350
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Country | US
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Telephone | 253-441-0598
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Fax | 253-761-1306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 37332
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License Number State | WA
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