Provider Demographics
NPI:1770279960
Name:VASILAS, ORION ALEXANDER
Entity type:Individual
Prefix:
First Name:ORION
Middle Name:ALEXANDER
Last Name:VASILAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 MOUNTAIN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1450
Mailing Address - Country:US
Mailing Address - Phone:530-246-7172
Mailing Address - Fax:
Practice Address - Street 1:4625 MOUNTAIN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-1450
Practice Address - Country:US
Practice Address - Phone:530-246-7171
Practice Address - Fax:530-246-0736
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator