Healthcare Provider Details

I. General information

NPI: 1467081778
Provider Name (Legal Business Name): ISABELLA MARIA VELASCO MASLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CHESTNUT ST
LOUISVILLE KY
40202-1831
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6789
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-6000
  • Fax: 502-852-8556
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.42954
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD.42954
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number61760
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: