Organization
VITELLARIA LLC
Active
Organization
VITELLARIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH PAUL PMHNP (OWNER)
(503) 781-3278
Entity
Organization
Contact information
Practice address
9735 SW SHADY LN STE 104, TIGARD, OR 97223-5481
(503) 707-6302
(503) 747-4023
Mailing address
9735 SW SHADY LN STE 104, TIGARD, OR 97223-5481
(503) 707-6302
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/20/2022
Last updated
07/31/2024
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