Healthcare Provider Details

I. General information

NPI: 1619840675
Provider Name (Legal Business Name): TIA RODRIGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 OAK ST SE
SALEM OR
97301-3905
US

IV. Provider business mailing address

1060 BENTLEY ST E
MONMOUTH OR
97361-9734
US

V. Phone/Fax

Practice location:
  • Phone: 503-561-5200
  • Fax:
Mailing address:
  • Phone: 503-917-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number200843473RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: