Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Vila Phoulavan, PA-C

Individual provider Medical Physician Assistant · NPI 1184705212

Vila Phoulavan, PA-C is a Physician Assistant in Berkeley, California. Qualified in 2004, 22 years ago. Practices with Sutter Bay Medical Foundation, a 3,762-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
22
Licensed in
CA
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2500 Milvia St
Berkeley, CA 94704-2636
Phone: (510) 204-5514
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 101 Casa Buena Dr, Corte Madera, CA 94925-1762 — (415) 924-4525

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 17855 (CA)

Record details

NPI number1184705212
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 17, 2006
Last updated in NPPESOctober 30, 2024
Certification dateOctober 30, 2024
Mailing address6220 Fairlane Dr Unit B, Oakland, CA 94611-1810

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Sutter Bay Medical Foundation — 3762 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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