Provider Demographics
NPI:1528477817
Name:VRVILO, ERICA (PA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:VRVILO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101895
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-1895
Mailing Address - Country:US
Mailing Address - Phone:503-828-9569
Mailing Address - Fax:503-828-9056
Practice Address - Street 1:11750 SW BARNES RD STE 270
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5911
Practice Address - Country:US
Practice Address - Phone:503-828-9569
Practice Address - Fax:503-828-9056
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007273363A00000X
ORPA185646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant