Healthcare Provider Details

I. General information

NPI: 1003720822
Provider Name (Legal Business Name): MANASVI RAIYANI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 NE BROADWAY STE 200
PORTLAND OR
97213-1425
US

IV. Provider business mailing address

4425 NE BROADWAY STE 200
PORTLAND OR
97213-1425
US

V. Phone/Fax

Practice location:
  • Phone: 503-258-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: