Provider Demographics
NPI:1790575801
Name:ESPIRITU, RHUDOLF MARAVILLA JR (NP)
Entity type:Individual
Prefix:
First Name:RHUDOLF
Middle Name:MARAVILLA
Last Name:ESPIRITU
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:MARAVILLA
Other - Last Name:ESPIRITU
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:12933 65TH AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1002
Mailing Address - Country:US
Mailing Address - Phone:719-231-3985
Mailing Address - Fax:
Practice Address - Street 1:12933 65TH AVENUE CT SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1002
Practice Address - Country:US
Practice Address - Phone:719-231-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty