Provider Demographics
NPI:1790482412
Name:RODRIGUEZ-VIVAR, LUIS ALFREDO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALFREDO
Last Name:RODRIGUEZ-VIVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 NE ELAM YOUNG PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6438
Mailing Address - Country:US
Mailing Address - Phone:503-846-4555
Mailing Address - Fax:
Practice Address - Street 1:5240 NE ELAM YOUNG PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6438
Practice Address - Country:US
Practice Address - Phone:503-846-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator