Provider Demographics
NPI:1285202515
Name:ESPIRITU, RAYMOND C
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:ESPIRITU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6007
Mailing Address - Country:US
Mailing Address - Phone:707-435-9911
Mailing Address - Fax:
Practice Address - Street 1:1143 MISSOURI ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6007
Practice Address - Country:US
Practice Address - Phone:707-435-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284123164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty