Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A156386 | CA |
N | 208600000X | Surgeon | A156386 | CA |
Y | 2086S0129X | Vascular Surgeon | A156386 | CA |
NPI | 1023329638 |
---|---|
Provider Name | Prince C Esiobu |
First Address | Corona, CA 92878-2828 |
Second Address | Riverside, CA 92504-3849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 13/01/2020 |