Healthcare Provider Details

I. General information

NPI: 1801713375
Provider Name (Legal Business Name): KECYMAR AGUETE OSUNA RUBIO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 S HIGUERA ST STE 102
SAN LUIS OBISPO CA
93401-7719
US

IV. Provider business mailing address

315 CALLE DE PUEBLO
TEMPLETON CA
93465-5428
US

V. Phone/Fax

Practice location:
  • Phone: 805-505-9899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: