MEDICARE: RIANNA CHRISTINE VELASQUEZ II

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	175T00000X	Peer Specialist		OR

General Provider Information

NPI Number	:	1922860576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIANNA CHRISTINE VELASQUEZ II

Provider Business Mailing Address
First Line	:	18361 NE MULTNOMAH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-7142
Country	:	US
Telephone Number	:	503-351-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	18361 NE MULTNOMAH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-7142
Country	:	US
Telephone Number	:	503-351-3839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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Directions to “ RIANNA CHRISTINE VELASQUEZ II ” Practice Location

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