1073764791 NPI number — MS. GUILLERMINA OSORIA LICENSED INSURANCE,

Table of content: MS. GUILLERMINA OSORIA LICENSED INSURANCE, (NPI 1073764791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073764791 NPI number — MS. GUILLERMINA OSORIA LICENSED INSURANCE,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSORIA
Provider First Name:
GUILLERMINA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED INSURANCE,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073764791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 S RIVERSIDE DR STE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESPANOLA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87532-3394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-753-3512
Provider Business Mailing Address Fax Number:
888-504-0115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 S RIVERSIDE DR STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-3394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-595-4848
Provider Business Practice Location Address Fax Number:
888-504-0115
Provider Enumeration Date:
10/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172A00000X , with the licence number: 053063484 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175T00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X , with the licence number: CN0028898365 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)