Provider Demographics
NPI:1033523675
Name:MUPOMBWA, TARIRO (MD)
Entity Type:Individual
Prefix:
First Name:TARIRO
Middle Name:
Last Name:MUPOMBWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VIRGINIA MASON MEDICAL CENTER
Mailing Address - Street 2:1100 9TH AVENUE, X8-GYN
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VIRGINIA MASON MEDICAL CENTER
Practice Address - Street 2:1100 9TH AVENUE, X8-GYN
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-223-6191
Practice Address - Fax:206-625-7274
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD18987207V00000X
WA60844929207VG0400X
WAMD60844929207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology