Provider Demographics
NPI:1457135055
Name:PORRAS, RUBY
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:PORRAS
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 1:430 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9543
Mailing Address - Country:US
Mailing Address - Phone:503-857-8486
Mailing Address - Fax:
Practice Address - Street 1:2586 12TH PL SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2536
Practice Address - Country:US
Practice Address - Phone:150-391-0057
Practice Address - Fax:503-375-9727
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)