Basic Information
| Provider Information | |||||||||
| NPI: | 1174724678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ONIWOR | ||||||||
| FirstName: | ESEOGHENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | I | ||||||||
| Credential: | BS, MARRIAGE AND FAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2999 KENDALL DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924072436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096446161 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2999 KENDALL DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924072436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096236131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 52885 | 01 | CA | BOARD OF BEHAVIORAL SCIENCES | OTHER |