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General NPI Number Information
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NPI Number | 1811463557
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Entity Type | Individual
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Provider Name | JESSICA RUTH RUVALCABA RDH
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Gender | Female
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Dates
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Enumeration Date | 10/20/2018
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 500 NE MULTNOMAH ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97232-2031
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Country | US
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Telephone | 800-448-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 989 SAGRADA CIR N
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City | KEIZER
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State | OR
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Zip | 97303-3784
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Country | US
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Telephone | 503-339-5700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H5064
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License Number State | OR
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