Healthcare Provider Details

I. General information

NPI: 1780024828
Provider Name (Legal Business Name): LYNETTE OSBORNE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

IV. Provider business mailing address

PO BOX 3674
FRESNO CA
93650-3674
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax: 559-992-7178
Mailing address:
  • Phone: 559-992-7100
  • Fax: 559-992-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY17069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: