=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801685375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLA MIDORI OSORIO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1509 BUENA VIS APT 202
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-5908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-202-6857
-----------------------------------------------------
Fax | 855-978-0433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 ELDERGLEN
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-316-7487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | 9317
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------