Provider Demographics
NPI:1295807436
Name:HOLEVAS, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HOLEVAS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-646-1131
Mailing Address - Fax:949-646-6782
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-646-1131
Practice Address - Fax:949-646-6782
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG66489208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G66489Medicaid
CAW1321BMedicare PIN
CAF22680Medicare UPIN