Provider Demographics
NPI:1629182852
Name:FERNANDEZ-HOLTZMAN, ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:
Last Name:FERNANDEZ-HOLTZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7766
Mailing Address - Country:US
Mailing Address - Phone:636-349-5437
Mailing Address - Fax:636-349-6663
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:STE 200
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7766
Practice Address - Country:US
Practice Address - Phone:636-349-5437
Practice Address - Fax:636-349-6663
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002012674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205948003Medicaid