MEDICARE: EDGARDO A OSEA M D INC

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
1	261Q00000X	Clinic/Center	A44654	CA

General Provider Information

NPI Number	:	1033398136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGARDO A OSEA M D INC

Provider Business Mailing Address
First Line	:	1310 SEPULVEDA BLVD
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-1156
Country	:	US
Telephone Number	:	310-534-5765
Fax Number	:	310-534-5913

Provider Business Practice Location Address
First Line	:	1310 SEPULVEDA BLVD
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-1156
Country	:	US
Telephone Number	:	310-534-5765
Fax Number	:	310-534-5913

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. EDGARDO ALVAREZ OSEA
Credential	:	M.D.
Telephone Number	:	310-534-5765

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	01/22/2009

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