Healthcare Provider Details

I. General information

NPI: 1992900062
Provider Name (Legal Business Name): AUDLEY LLOYD MARTIN OSBOURNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 WILSHIRE BLVD STE 600
LOS ANGELES CA
90025-1776
US

IV. Provider business mailing address

402 W COLTON AVE
REDLANDS CA
92374-3108
US

V. Phone/Fax

Practice location:
  • Phone: 310-876-5649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-224804
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME113487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: