Healthcare Provider Details

I. General information

NPI: 1982453312
Provider Name (Legal Business Name): OSCAR DE JESUS RAYO OSUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E C CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

1145 S SPRUCE ST
MONTEBELLO CA
90640-6119
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-5000
  • Fax:
Mailing address:
  • Phone: 323-314-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE143578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: