Provider Demographics
NPI:1336992064
Name:AIGBUZA, ESEOSA OSARENOMA
Entity Type:Individual
Prefix:
First Name:ESEOSA
Middle Name:OSARENOMA
Last Name:AIGBUZA
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 1:3680 VIRDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1566
Mailing Address - Country:US
Mailing Address - Phone:510-338-8700
Mailing Address - Fax:
Practice Address - Street 1:3680 VIRDEN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1566
Practice Address - Country:US
Practice Address - Phone:510-338-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46652390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program