Healthcare Provider Details

I. General information

NPI: 1558050633
Provider Name (Legal Business Name): ESEOSA JENNIFER SANWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 E FLORIDA AVE
HEMET CA
92544-4707
US

IV. Provider business mailing address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

V. Phone/Fax

Practice location:
  • Phone: 951-765-4910
  • Fax: 951-791-4380
Mailing address:
  • Phone: 951-652-2811
  • Fax: 951-791-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: