Provider Demographics
NPI:1043513179
Name:ESPIRITU, DANIEL CARLOS (LAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CARLOS
Last Name:ESPIRITU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:CARLOS
Other - Last Name:ESPIRITU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:9718 SE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2522
Mailing Address - Country:US
Mailing Address - Phone:971-803-0619
Mailing Address - Fax:
Practice Address - Street 1:2133 NE BROADWAY ST STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1878
Practice Address - Country:US
Practice Address - Phone:971-803-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150606171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist