MEDICARE: ESOSA OGUNBOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle		CA

General Provider Information

NPI Number	:	1376365064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESOSA OGUNBOR

Provider Business Mailing Address
First Line	:	9965 RED TAIL HAWK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95829-9604
Country	:	US
Telephone Number	:	951-763-7826
Fax Number	:

Provider Business Practice Location Address
First Line	:	9965 RED TAIL HAWK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95829-9604
Country	:	US
Telephone Number	:	951-763-7826
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	10/25/2024

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Directions to “ ESOSA OGUNBOR ” Practice Location

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