Provider Demographics
NPI:1124665914
Name:CHONG, ROLANDO LUIS (MHT2)
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:LUIS
Last Name:CHONG
Suffix:
Gender:M
Credentials:MHT2
Other - Prefix:MRS
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:326 CARNELIA ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2077
Mailing Address - Country:US
Mailing Address - Phone:503-581-2418
Mailing Address - Fax:
Practice Address - Street 1:326 CARNELIA ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2077
Practice Address - Country:US
Practice Address - Phone:503-581-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR843689354374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR519207OtherOREGON HEALTH AUTHORITY