Provider Demographics
NPI:1053881987
Name:MARYAM ESHO, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARYAM ESHO, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-573-3333
Mailing Address - Street 1:1729 N OLIVE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2501
Mailing Address - Country:US
Mailing Address - Phone:209-668-6900
Mailing Address - Fax:209-668-6903
Practice Address - Street 1:1729 N OLIVE AVE STE 7
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2501
Practice Address - Country:US
Practice Address - Phone:209-573-3333
Practice Address - Fax:209-844-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty