Provider Demographics
NPI:1730174970
Name:ESPIRITU, JULIAN LLADO (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:LLADO
Last Name:ESPIRITU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1476
Mailing Address - Country:US
Mailing Address - Phone:304-720-5000
Mailing Address - Fax:304-720-5003
Practice Address - Street 1:24 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1476
Practice Address - Country:US
Practice Address - Phone:304-720-5000
Practice Address - Fax:304-720-5003
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0071269000Medicaid
WV14901OtherSTATE LICENSE
WV14901OtherSTATE LICENSE
WV14901OtherSTATE LICENSE
WVBE0756950OtherDEA