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General NPI Number Information
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NPI Number | 1285252676
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Entity Type | Individual
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Provider Name | RODRIGO TZOVENOS STAROSTA MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2020
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8307
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8307
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2021014980
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TL.0009647
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207SM0001X
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Taxonomy Name | Molecular Genetic Pathology (Medical Genetics) Physician
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License Number | MD219636
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License Number State | OR
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