Provider Demographics
NPI:1619533346
Name:RUVALCABA LOZANO, CAROLINA (HIS)
Entity Type:Individual
Prefix:MS
First Name:CAROLINA
Middle Name:
Last Name:RUVALCABA LOZANO
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MS
Other - First Name:LINA
Other - Middle Name:
Other - Last Name:RUVALCABA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HIS
Mailing Address - Street 1:1301 EVERGREEN RD STE E
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-2826
Mailing Address - Country:US
Mailing Address - Phone:503-981-8575
Mailing Address - Fax:503-981-3062
Practice Address - Street 1:1301 EVERGREEN RD STE 120
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2802
Practice Address - Country:US
Practice Address - Phone:503-981-8575
Practice Address - Fax:503-981-3062
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10197927237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist