Healthcare Provider Details

I. General information

NPI: 1700702537
Provider Name (Legal Business Name): RUDY LEI ISHIBASHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 RIVER RD
EUGENE OR
97404-3212
US

IV. Provider business mailing address

2477 W 29TH AVE
EUGENE OR
97405-1431
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-2611
  • Fax:
Mailing address:
  • Phone: 541-953-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: