Provider Demographics
NPI:1093695793
Name:ALCALA MEZA, RICARDO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:ALCALA MEZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2278
Mailing Address - Country:US
Mailing Address - Phone:503-228-9229
Mailing Address - Fax:503-228-9558
Practice Address - Street 1:10209 SE DIVISION ST BLDG C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1372
Practice Address - Country:US
Practice Address - Phone:503-221-9229
Practice Address - Fax:503-228-9558
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-CRM-4565175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist