Healthcare Provider Details

I. General information

NPI: 1114837903
Provider Name (Legal Business Name): MARBELLA ALEJANDRA RUIZ CASTRO QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 TOWN CENTRE DR STE C
MEDFORD OR
97504-6188
US

IV. Provider business mailing address

2762 HIGH CEDARS LN
MEDFORD OR
97504-3416
US

V. Phone/Fax

Practice location:
  • Phone: 458-226-6282
  • Fax: 541-200-6151
Mailing address:
  • Phone: 458-226-6282
  • Fax: 541-200-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: