Healthcare Provider Details

I. General information

NPI: 1598591356
Provider Name (Legal Business Name): RODRIGO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 SE 50TH AVE APT 117
PORTLAND OR
97206-1577
US

IV. Provider business mailing address

78800 DOWNEY RD
BOARDMAN OR
97818-9696
US

V. Phone/Fax

Practice location:
  • Phone: 541-371-0853
  • Fax:
Mailing address:
  • Phone: 541-371-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10003240
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: