Healthcare Provider Details

I. General information

NPI: 1235003674
Provider Name (Legal Business Name): GABRIELA QUINONEZ RIEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD
GRESHAM OR
97030-6722
US

IV. Provider business mailing address

1326 SE RHONE ST
PORTLAND OR
97202-3848
US

V. Phone/Fax

Practice location:
  • Phone: 503-740-7075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: