Healthcare Provider Details

I. General information

NPI: 1386419745
Provider Name (Legal Business Name): JULIANNA RUOTOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 302
BEND OR
97701-4279
US

IV. Provider business mailing address

3818 SW 21ST ST STE 100
REDMOND OR
97756-6802
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4200
  • Fax: 541-797-5820
Mailing address:
  • Phone: 541-548-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number222430
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: