Healthcare Provider Details

I. General information

NPI: 1437067980
Provider Name (Legal Business Name): JAVIER VEGA ORTIZ CADC-I, CRM-II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 SW CEDAR HILLS BLVD STE 170
BEAVERTON OR
97005-2020
US

IV. Provider business mailing address

3800 SW CEDAR HILLS BLVD STE 170
BEAVERTON OR
97005-2020
US

V. Phone/Fax

Practice location:
  • Phone: 503-626-1800
  • Fax:
Mailing address:
  • Phone: 503-626-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number24-CRM-II-0199
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24-02-11009
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: