Healthcare Provider Details

I. General information

NPI: 1184660748
Provider Name (Legal Business Name): SORIN BILAUCA PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 ROYAL AVE SUITE 450
MEDFORD OR
97504-6193
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-7850
  • Fax: 541-732-7851
Mailing address:
  • Phone: 541-732-7850
  • Fax: 541-732-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2824
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA16759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: