Healthcare Provider Details

I. General information

NPI: 1265304984
Provider Name (Legal Business Name): CARLO DAQUIGAN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 AUBURN WAY N
AUBURN WA
98002-1805
US

IV. Provider business mailing address

1887 WHITNEY MESA DR # 4832
HENDERSON NV
89014-2069
US

V. Phone/Fax

Practice location:
  • Phone: 253-999-5750
  • Fax:
Mailing address:
  • Phone: 253-999-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLP60141113
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: