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General NPI Number Information
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NPI Number | 1124620224
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Entity Type | Individual
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Provider Name | OMOBOLANLE M ESAN
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Gender | Female
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 6405 MIRA MESA BLVD STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92121-4146
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Country | US
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Telephone | 866-701-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 43RD ST APT 3
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City | SAN DIEGO
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State | CA
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Zip | 92105-2674
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 83472
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License Number State | CA
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