Individual
LIYA KURUVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4400 NE HALSEY ST STE 102, PORTLAND, OR 97213-1545
(503) 962-1000
Mailing address
4400 NE HALSEY ST STE 102, PORTLAND, OR 97213-1545
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085007334
IL
363A00000X
Physician Assistant
Primary
PA226765
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085007334
IL PA LICENSE NUMBER
IL
Enumeration date
01/28/2020
Last updated
11/04/2025
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