Healthcare Provider Details

I. General information

NPI: 1528301157
Provider Name (Legal Business Name): MR. BRUCE EUGENE OSBORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W VISTA WAY STE 407
VISTA CA
92083-5714
US

IV. Provider business mailing address

1116 NARANCA AVE APT B
EL CAJON CA
92021-7409
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1092
  • Fax:
Mailing address:
  • Phone: 619-401-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: