Healthcare Provider Details

I. General information

NPI: 1780492884
Provider Name (Legal Business Name): MRS. KALI ANN GIARITTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 04/04/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

6419 SE 84TH AVE
PORTLAND OR
97266-5440
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax:
Mailing address:
  • Phone: 732-330-8789
  • Fax: 732-330-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: