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General NPI Number Information
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NPI Number | 1619349826
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Entity Type | Individual
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Provider Name | MARISSA CALDARELLA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 2659 STATE ST # 100-1012
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City | CARLSBAD
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State | CA
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Zip | 92008-1627
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Country | US
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Telephone | 833-378-2162
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Fax |
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Provider Business Mailing Address
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Address Line | 703 BROADWAY ST STE 700
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City | VANCOUVER
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State | WA
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Zip | 98660-3307
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Country | US
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Telephone | 360-869-4200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86007582
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61211939
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License Number State | WA
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