Healthcare Provider Details

I. General information

NPI: 1659895563
Provider Name (Legal Business Name): ANGELO ESPIRITU L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E AVENIDA DE LOS ARBOLES STE 105
THOUSAND OAKS CA
91360-3017
US

IV. Provider business mailing address

430 E AVENIDA DE LOS ARBOLES STE 105
THOUSAND OAKS CA
91360-3017
US

V. Phone/Fax

Practice location:
  • Phone: 805-768-4045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: