Provider Demographics
NPI:1790412070
Name:LOPEZ MORALES, RUBY MICHELLE
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:MICHELLE
Last Name:LOPEZ MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BRANDYWINE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-5533
Mailing Address - Country:US
Mailing Address - Phone:503-477-3354
Mailing Address - Fax:
Practice Address - Street 1:29174 SW TOWN CENTER LOOP W STE 101
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9309
Practice Address - Country:US
Practice Address - Phone:971-252-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10223913106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician