Healthcare Provider Details

I. General information

NPI: 1407654692
Provider Name (Legal Business Name): WINDELLYN C OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE FL 2
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-5000
  • Fax:
Mailing address:
  • Phone: 213-926-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: