Healthcare Provider Details

I. General information

NPI: 1215966205
Provider Name (Legal Business Name): OSO HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17175 GILLETTE AVE
IRVINE CA
92614-5602
US

IV. Provider business mailing address

17175 GILLETTE AVE
IRVINE CA
92614-5602
US

V. Phone/Fax

Practice location:
  • Phone: 949-660-7126
  • Fax:
Mailing address:
  • Phone: 949-660-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberPHY 43383
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY 43383
License Number StateCA

VIII. Authorized Official

Name: DR. RANDY DOUGLAS BOHART
Title or Position: PRESIDENT
Credential: PHARM. D
Phone: 949-660-7126