Healthcare Provider Details

I. General information

NPI: 1750200259
Provider Name (Legal Business Name): OSBORNE MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 GLENOAKS BLVD STE 8
PACOIMA CA
91331-7278
US

IV. Provider business mailing address

10750 GLENOAKS BLVD STE 8
PACOIMA CA
91331-7278
US

V. Phone/Fax

Practice location:
  • Phone: 818-924-5450
  • Fax: 818-924-5452
Mailing address:
  • Phone: 818-924-5450
  • Fax: 818-924-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RUBEN AVETISYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-966-2770