Healthcare Provider Details

I. General information

NPI: 1750755799
Provider Name (Legal Business Name): WENDY HOLT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 PERA AVE
EL PASO TX
79905-2412
US

IV. Provider business mailing address

3607 RIVERA AVE
EL PASO TX
79905-2415
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7057
  • Fax: 915-533-7158
Mailing address:
  • Phone: 915-533-7057
  • Fax: 915-533-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: