Provider Demographics
NPI:1679679245
Name:HOLTZ, ANITA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JEAN
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3554
Mailing Address - Country:US
Mailing Address - Phone:505-988-9821
Mailing Address - Fax:
Practice Address - Street 1:CEDAR STREET #4 SAN FELIPE PUEBLO
Practice Address - Street 2:BOX 4344
Practice Address - City:SAN FELIPE
Practice Address - State:NM
Practice Address - Zip Code:87001-4529
Practice Address - Country:US
Practice Address - Phone:505-867-2739
Practice Address - Fax:505-867-6527
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH48581Medicare UPIN