Provider Demographics
NPI:1609649599
Name:VIRLA, OSCAR ALONSO (SA-C)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:ALONSO
Last Name:VIRLA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 N ELSTON AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1859
Mailing Address - Country:US
Mailing Address - Phone:941-580-1641
Mailing Address - Fax:
Practice Address - Street 1:18761 CHESTNUT CT
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9501
Practice Address - Country:US
Practice Address - Phone:786-448-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000790363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical