Healthcare Provider Details

I. General information

NPI: 1477907822
Provider Name (Legal Business Name): MELISSA OSBORN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 PIER AVE UNIT 1352
HERMOSA BEACH CA
90254-8281
US

IV. Provider business mailing address

1000 CORDOVA PL PMB 915
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 949-371-9773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA175477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: