Provider Demographics
NPI:1851892830
Name:REVERON, JORGE ALEJANDRO (ND)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALEJANDRO
Last Name:REVERON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 PACIFIC AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-3135
Mailing Address - Country:US
Mailing Address - Phone:503-406-8450
Mailing Address - Fax:
Practice Address - Street 1:9735 SW SHADY LN STE 303
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5481
Practice Address - Country:US
Practice Address - Phone:503-594-7373
Practice Address - Fax:888-346-7793
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1683175F00000X
OR4395175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath