Healthcare Provider Details

I. General information

NPI: 1265220248
Provider Name (Legal Business Name): ORION JAY RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NE MARTIN LUTHER KING BLVD
PORTLAND OR
97232-2941
US

IV. Provider business mailing address

30 NE MARTIN LUTHER KING BLVD
PORTLAND OR
97232-2941
US

V. Phone/Fax

Practice location:
  • Phone: 503-232-1099
  • Fax:
Mailing address:
  • Phone: 650-219-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number105615
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: