Healthcare Provider Details

I. General information

NPI: 1821079757
Provider Name (Legal Business Name): LEWIS A OSOFSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EL CAMINO REAL BUILDING 701
SANTA CLARA CA
95053-1055
US

IV. Provider business mailing address

500 EL CAMINO REAL BLDG 701
SANTA CLARA CA
95053-1055
US

V. Phone/Fax

Practice location:
  • Phone: 408-554-4501
  • Fax: 408-554-2376
Mailing address:
  • Phone: 408-554-4501
  • Fax: 408-554-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG47908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: