Individual
FERNANDO EGUILUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3645 N BEACH ST, FORT WORTH, TX 76137-3242
(817) 759-0004
Mailing address
3645 N BEACH ST, FORT WORTH, TX 76137-3242
(254) 654-8116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA09644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1092275
NCCPA
—
Enumeration date
11/11/2010
Last updated
10/02/2023
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