Provider Demographics
NPI:1326748633
Name:HAVILI, VILCA FAUIKI (PA-C)
Entity type:Individual
Prefix:
First Name:VILCA
Middle Name:FAUIKI
Last Name:HAVILI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NE KENNETH FORD DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1042
Mailing Address - Country:US
Mailing Address - Phone:541-672-9596
Mailing Address - Fax:
Practice Address - Street 1:790 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9303
Practice Address - Country:US
Practice Address - Phone:541-860-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant