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General NPI Number Information
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NPI Number | 1699213124
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Entity Type | Individual
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Provider Name | IAN-PHILIP ROJAS ATC
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Gender | Male
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2000 SE CENTURY BLVD RM N130
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City | HILLSBORO
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State | OR
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Zip | 97123-8390
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Country | US
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Telephone | 503-844-1849
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Fax |
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Provider Business Mailing Address
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Address Line | 12208 NW BARNES RD APT 224
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City | PORTLAND
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State | OR
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Zip | 97229-6024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-AT-10185047
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License Number State | OR
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