Healthcare Provider Details

I. General information

NPI: 1043158173
Provider Name (Legal Business Name): AVILA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10365 SE SUNNYSIDE RD STE 210
CLACKAMAS OR
97015-5749
US

IV. Provider business mailing address

10753 SE DEER FERN ST
HAPPY VALLEY OR
97086-9650
US

V. Phone/Fax

Practice location:
  • Phone: 573-719-8770
  • Fax:
Mailing address:
  • Phone: 573-719-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MANUEL BASTARDO
Title or Position: OWNER
Credential:
Phone: 573-719-8770