Provider Demographics
NPI:1558013243
Name:LOPEZ RIVERA, YESABEL
Entity Type:Individual
Prefix:
First Name:YESABEL
Middle Name:
Last Name:LOPEZ RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 NW RALEIGH ST APT 263
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2295
Mailing Address - Country:US
Mailing Address - Phone:347-367-8430
Mailing Address - Fax:
Practice Address - Street 1:2050 NW RALEIGH ST APT 263
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2295
Practice Address - Country:US
Practice Address - Phone:347-367-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist