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NPI Code Detail

MEDICARE: ELLEN GRIMES OSBORNE PA

MEDICARE: ELLEN GRIMES OSBORNE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA12484CA

General Provider Information

NPI Number : 1023203569
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN GRIMES OSBORNE PA
Provider Business Mailing Address
First Line : 8835 VANS ST
Second Line :
City : PARAMOUNT
State : CA
Zip : 90723-4656
Country : US
Telephone Number : 562-633-5111
Fax Number :
Provider Business Practice Location Address
First Line : 8835 VANS ST
Second Line :
City : PARAMOUNT
State : CA
Zip : 90723-4656
Country : US
Telephone Number : 562-633-5111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2007
Last Update Date : 09/07/2007

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Directions to “ ELLEN GRIMES OSBORNE PA” Practice Location

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