Healthcare Provider Details

I. General information

NPI: 1215020060
Provider Name (Legal Business Name): DYAN J OSBORNE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 OAKDALE RD STANISLAUS SURGICAL HOSPITAL
MODESTO CA
95355
US

IV. Provider business mailing address

817 COFFEE RD C3
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-2700
  • Fax:
Mailing address:
  • Phone: 209-529-9603
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A6362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: