Healthcare Provider Details

I. General information

NPI: 1184950602
Provider Name (Legal Business Name): ELIZA HOFKOSH-HULBERT ND, LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SE CESAR E CHAVEZ BLVD
PORTLAND OR
97214-4322
US

IV. Provider business mailing address

1330 SE CESAR E CHAVEZ BLVD
PORTLAND OR
97214-4322
US

V. Phone/Fax

Practice location:
  • Phone: 503-232-1100
  • Fax: 503-232-7751
Mailing address:
  • Phone: 503-232-1100
  • Fax: 503-232-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: