Provider Demographics
NPI:1346495405
Name:MAGBANUA, COLE THOMPSON ESCOBAR (LAC)
Entity Type:Individual
Prefix:MR
First Name:COLE
Middle Name:THOMPSON ESCOBAR
Last Name:MAGBANUA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 SE CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3110
Mailing Address - Country:US
Mailing Address - Phone:503-252-1731
Mailing Address - Fax:
Practice Address - Street 1:10235 NE HOLLADAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3920
Practice Address - Country:US
Practice Address - Phone:503-252-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00386171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist