Healthcare Provider Details

I. General information

NPI: 1598597197
Provider Name (Legal Business Name): ALEXANDRIA OSUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

10761 MAGNOLIA AVE APT 104
ANAHEIM CA
92804-6264
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2335
  • Fax:
Mailing address:
  • Phone: 714-306-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA54592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: