Healthcare Provider Details

I. General information

NPI: 1194119172
Provider Name (Legal Business Name): IRINA ROZIN CASSIMATIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD # L466
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD # L466
PORTLAND OR
97239-3098
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-2101
  • Fax: 503-494-5296
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61270523
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD209836
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: