Provider Demographics
NPI:1639107568
Name:FERNANDEZ, EDUARDO (LAC)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 NE 14TH AVE.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211
Mailing Address - Country:US
Mailing Address - Phone:971-998-3155
Mailing Address - Fax:503-282-1697
Practice Address - Street 1:1800 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3389
Practice Address - Country:US
Practice Address - Phone:541-296-7585
Practice Address - Fax:541-296-7610
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00255171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist