Provider Demographics
NPI:1457931859
Name:ESAMBOLCHI, SHELBY SHANIA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:SHANIA
Last Name:ESAMBOLCHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 GINGER GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6913
Mailing Address - Country:US
Mailing Address - Phone:858-472-6823
Mailing Address - Fax:
Practice Address - Street 1:12925 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1891
Practice Address - Country:US
Practice Address - Phone:858-633-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist