Healthcare Provider Details

I. General information

NPI: 1134477375
Provider Name (Legal Business Name): PATRICIA ESPERANZA GUARDIOLA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13232 SE STARK ST SUITE 3
PORTLAND OR
97233-1573
US

IV. Provider business mailing address

15758 SE HIGHWAY 224 APT 1
DAMASCUS OR
97089-6417
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-2654
  • Fax: 503-256-2493
Mailing address:
  • Phone: 503-558-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15397
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: