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General NPI Number Information
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NPI Number | 1053881987
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Entity Type | Organization
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Legal Business Name | MARYAM ESHO, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 1729 N OLIVE AVE STE 7
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City | TURLOCK
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State | CA
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Zip | 95382-2501
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Country | US
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Telephone | 209-573-3333
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Fax | 209-844-0334
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Provider Business Mailing Address
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Address Line | 1729 N OLIVE AVE STE 7
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City | TURLOCK
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State | CA
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Zip | 95382-2501
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Country | US
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Telephone | 209-668-6900
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Fax | 209-668-6903
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Authorized Official
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Title or Position | AGENT
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Name | GINA WALLACE
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Credential |
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Telephone | 209-573-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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