Healthcare Provider Details

I. General information

NPI: 1043513179
Provider Name (Legal Business Name): DANIEL CARLOS ESPIRITU L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL CARLOS ESPIRITU L.AC

II. Dates (important events)

Enumeration Date: 12/11/2010
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 NE BROADWAY ST STE 301
PORTLAND OR
97232-1878
US

IV. Provider business mailing address

9718 SE STEPHENS ST
PORTLAND OR
97216-2522
US

V. Phone/Fax

Practice location:
  • Phone: 971-803-0619
  • Fax:
Mailing address:
  • Phone: 971-803-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC150606
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: