MEDICARE: LAURA RUBIALES ND, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00577	OR
2	175F00000X	Naturopath	1123	OR

General Provider Information

NPI Number	:	1134499692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA RUBIALES ND, LAC

Provider Business Mailing Address
First Line	:	4800 SW MACADAM AVE STE 307
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3927
Country	:	US
Telephone Number	:	503-241-5094
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SW MACADAM AVE STE 307
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3927
Country	:	US
Telephone Number	:	503-241-5094
Fax Number	:

Authorized Official
Title or Position	:	NATUROPATHIC DOCTOR, ACUPUNCTURIST
Name	:	DR. LAURA PORRO RUBIALES
Credential	:	ND, LAC
Telephone Number	:	503-241-5094

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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