Healthcare Provider Details

I. General information

NPI: 1073764791
Provider Name (Legal Business Name): GUILLERMINA OSORIA LICENSED INSURANCE,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S RIVERSIDE DR STE G
ESPANOLA NM
87532-3394
US

IV. Provider business mailing address

424 S RIVERSIDE DR STE G
ESPANOLA NM
87532-3394
US

V. Phone/Fax

Practice location:
  • Phone: 505-595-4848
  • Fax: 888-504-0115
Mailing address:
  • Phone: 505-753-3512
  • Fax: 888-504-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number053063484
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0028898365
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: