Healthcare Provider Details

I. General information

NPI: 1023718004
Provider Name (Legal Business Name): ISABELLA VIRGINIA FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 NE HIGHWAY 20
CORVALLIS OR
97330-9695
US

IV. Provider business mailing address

1224 W BELMONT AVE APT 3
CHICAGO IL
60657-9828
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-5900
  • Fax:
Mailing address:
  • Phone: 503-899-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number25-570
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: