Basic Information
| Provider Information | |||||||||
| NPI: | 1023329638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESIOBU | ||||||||
| FirstName: | PRINCE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2828 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928782828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512788870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925043849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512788870 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A156386 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | A156386 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.