Provider Demographics
NPI:1124835095
Name:JARIWALA, MITALI
Entity type:Individual
Prefix:
First Name:MITALI
Middle Name:
Last Name:JARIWALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E MAIN STE 103
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6768
Mailing Address - Country:US
Mailing Address - Phone:425-272-5855
Mailing Address - Fax:253-390-3033
Practice Address - Street 1:1011 E MAIN STE 103
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6768
Practice Address - Country:US
Practice Address - Phone:425-272-5855
Practice Address - Fax:253-390-3033
Is Sole Proprietor?:No
Enumeration Date:2024-12-14
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program