Healthcare Provider Details

I. General information

NPI: 1740920578
Provider Name (Legal Business Name): RAVALI SANTOSHI AMBATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 NW GREENBRIER PKWY STE 111
BEAVERTON OR
97006-7357
US

IV. Provider business mailing address

200 SW MARKET ST STE 1650
PORTLAND OR
97201-5739
US

V. Phone/Fax

Practice location:
  • Phone: 503-531-3434
  • Fax:
Mailing address:
  • Phone: 503-466-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD226161
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: