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General NPI Number Information
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NPI Number | 1265130181
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Entity Type | Organization
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Legal Business Name | ESIOBU MEDICAL GROUP PC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 255 TERRACINA BLVD STE 104B
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City | REDLANDS
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State | CA
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Zip | 92373-4870
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Country | US
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Telephone | 323-788-2794
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27670
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City | ANAHEIM
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State | CA
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Zip | 92809-0122
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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 | OWNER
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Name | PRINCE ESIOBU
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Credential | MD
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Telephone | 909-580-8272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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