Healthcare Provider Details

I. General information

NPI: 1932821469
Provider Name (Legal Business Name): GIANCARLO LUCA GENOVESI M.S., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8196 SW HALL BLVD STE 230
BEAVERTON OR
97008-6401
US

IV. Provider business mailing address

8196 SW HALL BLVD STE 230
BEAVERTON OR
97008-6401
US

V. Phone/Fax

Practice location:
  • Phone: 541-638-0830
  • Fax:
Mailing address:
  • Phone: 541-638-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: