Healthcare Provider Details

I. General information

NPI: 1508129867
Provider Name (Legal Business Name): ERIKA D LA VELLA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA KINZER D.O.

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 NW SAMARITAN DR STE 100
CORVALLIS OR
97330-3768
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPG158171
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO177162
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: