Provider Demographics
NPI:1821561622
Name:ESHOIEE, MIRIAM
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ESHOIEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PALATINE APT 404
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-5604
Mailing Address - Country:US
Mailing Address - Phone:949-413-1295
Mailing Address - Fax:
Practice Address - Street 1:360 SAN MIGUEL DR STE 309
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7829
Practice Address - Country:US
Practice Address - Phone:949-640-0434
Practice Address - Fax:949-640-0277
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56144363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant