Healthcare Provider Details

I. General information

NPI: 1083455257
Provider Name (Legal Business Name): MARISOL AVENDANO OSORIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4666 CARNEGIE ST
LOS ANGELES CA
90032-1407
US

IV. Provider business mailing address

4666 CARNEGIE ST
LOS ANGELES CA
90032-1407
US

V. Phone/Fax

Practice location:
  • Phone: 323-884-4575
  • Fax:
Mailing address:
  • Phone: 323-884-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95179765
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95179765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: