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 1:20033 SW DOMA LN APT 3
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3030
Mailing Address - Country:US
Mailing Address - Phone:281-318-1621
Mailing Address - Fax:
Practice Address - Street 1:17933 NW EVERGREEN PL STE 285
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7532
Practice Address - Country:US
Practice Address - Phone:503-828-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4395175F00000X
AZ17-1683175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath