Healthcare Provider Details

I. General information

NPI: 1497722359
Provider Name (Legal Business Name): ESPIRITU CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 FAIRGROVE CHURCH RD SE SUITE 204
CONOVER NC
28613-9290
US

IV. Provider business mailing address

2425 N CENTER ST 370
HICKORY NC
28601-1320
US

V. Phone/Fax

Practice location:
  • Phone: 888-898-7130
  • Fax: 828-322-7921
Mailing address:
  • Phone: 888-898-7130
  • Fax: 828-322-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. HERNANE BAUTISTA ESPIRITU
Title or Position: PRACTICE MANAGER
Credential:
Phone: 888-898-7130