Healthcare Provider Details

I. General information

NPI: 1578446084
Provider Name (Legal Business Name): KARLA BEATRIZ MARISCAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E ROSE ST STE M
WALLA WALLA WA
99362-5009
US

IV. Provider business mailing address

819 S 3RD AVE
WALLA WALLA WA
99362-4010
US

V. Phone/Fax

Practice location:
  • Phone: 360-572-8655
  • Fax:
Mailing address:
  • Phone: 509-200-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: