Provider Demographics
NPI:1316017700
Name:RUBIALES, LAURA P (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:P
Last Name:RUBIALES
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 SW CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4207
Mailing Address - Country:US
Mailing Address - Phone:503-224-2590
Mailing Address - Fax:503-224-2592
Practice Address - Street 1:4444 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4207
Practice Address - Country:US
Practice Address - Phone:503-224-2590
Practice Address - Fax:503-224-2592
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00577171100000X
OR1123175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath