Healthcare Provider Details

I. General information

NPI: 1649216110
Provider Name (Legal Business Name): ANDREA BETH RUOTOLO AU. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST SUITE 655
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

847 NE 19TH AVE SUITE 300
PORTLAND OR
97232-2684
US

V. Phone/Fax

Practice location:
  • Phone: 503-488-2400
  • Fax: 503-231-0121
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number21975
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: