Healthcare Provider Details

I. General information

NPI: 1912706508
Provider Name (Legal Business Name): ANGELIQUE OSBURN CBPA,CBS,CIMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HILLRISE CIR
LAS CRUCES NM
88011-4759
US

IV. Provider business mailing address

1350 HILLRISE CIR
LAS CRUCES NM
88011-4759
US

V. Phone/Fax

Practice location:
  • Phone: 575-805-1840
  • Fax:
Mailing address:
  • Phone: 575-805-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number000000
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: