Healthcare Provider Details

I. General information

NPI: 1497399034
Provider Name (Legal Business Name): DALE LAUREN OSBORN ASSOCIATE CLINICAL S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYLE LAUREN OSBORN ASSOCIATE CLINICAL S

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY STE. 100
LONG BEACH CA
90810
US

IV. Provider business mailing address

202 EAST BIXBY ROAD
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-6565
  • Fax: 562-685-0426
Mailing address:
  • Phone: 562-212-7382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number94293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: