Provider Demographics
NPI:1528563160
Name:TARASCO, ALEXANDER MARIO (ND)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MARIO
Last Name:TARASCO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:TARASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3660 SE 29TH AVE APT 2211
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2179
Mailing Address - Country:US
Mailing Address - Phone:503-984-9188
Mailing Address - Fax:
Practice Address - Street 1:9775 SE SUNNYSIDE RD STE 200
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5721
Practice Address - Country:US
Practice Address - Phone:503-655-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program