Provider Demographics
NPI:1508129867
Name:LA VELLA, ERIKA D (DO)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:D
Last Name:LA VELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:KINZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3517 NW SAMARITAN DR STE 100
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3768
Practice Address - Country:US
Practice Address - Phone:541-768-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG158171208600000X
ORDO177162208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500732270Medicaid