Healthcare Provider Details

I. General information

NPI: 1033373287
Provider Name (Legal Business Name): JOSE A OSPINA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

2200 N MAYFAIR RD SUITE 200
WAUWATOSA WI
53226-2252
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax: 818-546-5642
Mailing address:
  • Phone: 414-258-9511
  • Fax: 414-607-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301108735
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036129323
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME142683
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0025770
License Number StateDE
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA100569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: