Provider Demographics
NPI:1265220248
Name:RODRIGUEZ, ORION JAY (PSS, THW)
Entity type:Individual
Prefix:
First Name:ORION
Middle Name:JAY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PSS, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 NW FLANDERS ST APT 242
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3656
Mailing Address - Country:US
Mailing Address - Phone:650-219-3685
Mailing Address - Fax:
Practice Address - Street 1:30 NE MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2941
Practice Address - Country:US
Practice Address - Phone:503-232-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR105615172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker