Healthcare Provider Details

I. General information

NPI: 1669226759
Provider Name (Legal Business Name): ARIANNA OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23161 MILL CREEK DR STE 230
LAGUNA HILLS CA
92653-7935
US

IV. Provider business mailing address

4310 MOLINO
IRVINE CA
92618-4830
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-5350
  • Fax:
Mailing address:
  • Phone: 949-491-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: