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General NPI Number Information
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NPI Number | 1134477375
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Entity Type | Individual
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Provider Name | PATRICIA ESPERANZA GUARDIOLA LMT
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 13232 SE STARK ST SUITE 3
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City | PORTLAND
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State | OR
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Zip | 97233-1573
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Country | US
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Telephone | 503-256-2654
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Fax | 503-256-2493
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Provider Business Mailing Address
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Address Line | 15758 SE HIGHWAY 224 APT 1
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City | DAMASCUS
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State | OR
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Zip | 97089-6417
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Country | US
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Telephone | 503-558-9197
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15397
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License Number State | OR
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