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General NPI Number Information
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NPI Number | 1558008573
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Entity Type | Organization
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Legal Business Name | KRISTA TRICARICO, ND, PC
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 7005 NE GLISAN ST STE B
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City | PORTLAND
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State | OR
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Zip | 97213-5517
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Country | US
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Telephone | 503-593-8900
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Fax | 503-234-2805
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Provider Business Mailing Address
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Address Line | 6201 NE 13TH AVE UNIT B
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City | PORTLAND
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State | OR
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Zip | 97211-4270
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Country | US
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Telephone | 503-502-9490
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Fax | 503-234-2805
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTA A TRICARICO
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Credential | ND
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Telephone | 503-593-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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