Healthcare Provider Details

I. General information

NPI: 1053276121
Provider Name (Legal Business Name): ALYSSA ROJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 SE POWELL BLVD
PORTLAND OR
97202-3371
US

IV. Provider business mailing address

2330 NW RALEIGH ST APT 202
PORTLAND OR
97210-3844
US

V. Phone/Fax

Practice location:
  • Phone: 562-417-0433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: