Healthcare Provider Details

I. General information

NPI: 1740104546
Provider Name (Legal Business Name): EDITA OSMANOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20177 W THOMAS RD UNIT 331
BUCKEYE AZ
85396-1384
US

IV. Provider business mailing address

20177 W THOMAS RD UNIT 331
BUCKEYE AZ
85396-1384
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: