Provider Demographics
NPI:1225891450
Name:KEY FERNANDEZ, EDUARDO ESTEBAN (PA)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ESTEBAN
Last Name:KEY FERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 25603
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9603
Mailing Address - Country:US
Mailing Address - Phone:787-644-2449
Mailing Address - Fax:
Practice Address - Street 1:BARRIO HATO ARRIBA SECTOR LOS MARTINEZ
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-644-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1505PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical