Healthcare Provider Details

I. General information

NPI: 1598105868
Provider Name (Legal Business Name): ALEX OSORIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BOYS REPUBLIC DR
CHINO HILLS CA
91709-5447
US

IV. Provider business mailing address

1907 BOYS REPUBLIC DR
CHINO HILLS CA
91709-5447
US

V. Phone/Fax

Practice location:
  • Phone: 909-628-1217
  • Fax: 909-993-1106
Mailing address:
  • Phone: 909-627-1217
  • Fax: 909-627-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW81207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: