Healthcare Provider Details

I. General information

NPI: 1659208783
Provider Name (Legal Business Name): ESOMCHI UMEZURIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

7004 BIRD RD APT 328
MIAMI FL
33155-3878
US

V. Phone/Fax

Practice location:
  • Phone: 501-254-1734
  • Fax:
Mailing address:
  • Phone: 501-254-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN309210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: