Healthcare Provider Details

I. General information

NPI: 1457745200
Provider Name (Legal Business Name): ASHLEY NICOLE RIVERA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 SW BARNES RD STE 735
PORTLAND OR
97225-6634
US

IV. Provider business mailing address

541 NE 20TH AVE STE 225
PORTLAND OR
97232-2895
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-1351
  • Fax: 503-297-2851
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO197216
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: