Healthcare Provider Details

I. General information

NPI: 1679218275
Provider Name (Legal Business Name): MICHELLE RUVALCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SE 8TH AVE STE 212
HILLSBORO OR
97123-4218
US

IV. Provider business mailing address

3525 SW 122ND AVE APT 7
BEAVERTON OR
97005-1751
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-7333
  • Fax:
Mailing address:
  • Phone: 714-472-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: