Individual
VILA PHOULAVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2500 MILVIA ST, BERKELEY, CA 94704-2636
(510) 204-5514
Mailing address
6220 FAIRLANE DR UNIT B, OAKLAND, CA 94611-1810
(510) 735-1891
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
17855
CA
Other
Enumeration date
10/17/2006
Last updated
10/30/2024
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