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NPI Code Detail

MEDICARE: DR. RODRIGO TZOVENOS STAROSTA MD, PHD

MEDICARE: DR. RODRIGO TZOVENOS STAROSTA MD, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician2021014980MO
2390200000XStudent in an Organized Health Care Education/Training ProgramTL.0009647CO
3207SM0001XMolecular Genetic Pathology (Medical Genetics) PhysicianMD219636OR

General Provider Information

NPI Number : 1285252676
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODRIGO TZOVENOS STAROSTA MD, PHD
Provider Business Mailing Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3011
Country : US
Telephone Number : 503-494-8307
Fax Number :
Provider Business Practice Location Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3011
Country : US
Telephone Number : 503-494-8307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2020
Last Update Date : 10/11/2024

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