Healthcare Provider Details

I. General information

NPI: 1124985247
Provider Name (Legal Business Name): ORLANDO ANTONIO MORALES GUERRA CSFA,CSA,CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SE PARKWAY DR
WINSTON OR
97496-9585
US

IV. Provider business mailing address

615 SE PARKWAY DR
WINSTON OR
97496-9585
US

V. Phone/Fax

Practice location:
  • Phone: 541-941-2066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: