# WHOLE LIFE VITALITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316236847
- **Authorized official:** GIBRAN KEKOA RAMOS (OWNER)
- **Authorized official phone:** (503) 482-9092

## Contact information

- **Practice address:** 3942 SE HAWTHORNE BLVD, PORTLAND, OR 97214-5242
- **Practice address phone:** (503) 208-4546
- **Practice address fax:** (503) 715-5789
- **Mailing address:** 4110 SE HAWTHORNE BLVD \# 178, PORTLAND, OR 97214-5246
- **Mailing address phone:** (503) 482-9092
- **Mailing address fax:** (503) 715-5789

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 63999099 | OR | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/05/2011
- **Last updated:** 05/23/2025