Provider Demographics
NPI:1023497526
Name:WARILA, JEFFERY (CPO)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:WARILA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17316 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6026
Mailing Address - Country:US
Mailing Address - Phone:503-257-6623
Mailing Address - Fax:503-257-6624
Practice Address - Street 1:17316 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6026
Practice Address - Country:US
Practice Address - Phone:503-257-6623
Practice Address - Fax:503-257-6624
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297519Medicaid
5606990001Medicare PIN