Healthcare Provider Details

I. General information

NPI: 1932012721
Provider Name (Legal Business Name): ISABEL FERNANDEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 MAIN ST PO BOX 3339
UNION GAP WA
98903
US

IV. Provider business mailing address

3514 MAIN ST PO BOX 3339
UNION GAP WA
98903
US

V. Phone/Fax

Practice location:
  • Phone: 509-870-8884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: