Provider Demographics
NPI:1689565665
Name:FERNANDEZ, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 PERRIN CENTRAL BLVD APT 616
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2726
Mailing Address - Country:US
Mailing Address - Phone:910-916-4874
Mailing Address - Fax:
Practice Address - Street 1:1922 DRY CREEK WAY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-1840
Practice Address - Country:US
Practice Address - Phone:910-916-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician