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General NPI Number Information
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NPI Number | 1043324213
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Entity Type | Individual
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Provider Name | JUDITH ROBIN HOLEVA D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5536 SE WOODSTOCK BLVD
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City | PORTLAND
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State | OR
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Zip | 97206-6829
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Country | US
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Telephone | 503-236-1830
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Fax | 503-236-1908
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Provider Business Mailing Address
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Address Line | 2800 SW 257TH AVE
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City | TROUTDALE
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State | OR
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Zip | 97060-1803
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Country | US
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Telephone | 503-667-7711
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Fax | 503-669-9908
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO19080
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License Number State | OR
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