1497399034 NPI number — MS. DALE LAUREN OSBORN ASSOCIATE CLINICAL S

Table of content: MS. DALE LAUREN OSBORN ASSOCIATE CLINICAL S (NPI 1497399034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497399034 NPI number — MS. DALE LAUREN OSBORN ASSOCIATE CLINICAL S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBORN
Provider First Name:
DALE
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ASSOCIATE CLINICAL S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSBORN
Provider Other First Name:
DAYLE
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ASSOCIATE CLINICAL S
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497399034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 EAST BIXBY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-212-7382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 HUGHES WAY
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-548-6565
Provider Business Practice Location Address Fax Number:
562-685-0426
Provider Enumeration Date:
11/06/2019

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 94293 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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