Provider Demographics
NPI:1255980777
Name:ESOMONU, JUSTINE NNAEMEKA
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:NNAEMEKA
Last Name:ESOMONU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 E ST APT 406
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5231
Mailing Address - Country:US
Mailing Address - Phone:925-214-8468
Mailing Address - Fax:
Practice Address - Street 1:1182 E ST APT 406
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5231
Practice Address - Country:US
Practice Address - Phone:925-214-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician