Healthcare Provider Details

I. General information

NPI: 1336509132
Provider Name (Legal Business Name): ANGIE OSUNA ACOSTA CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 LONGBRANCH AVE
GROVER BEACH CA
93433-2508
US

IV. Provider business mailing address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4558
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-7007
  • Fax:
Mailing address:
  • Phone: 805-781-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC055540518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: