MEDICARE: JOSE LUIS OSORIA D.D.S.

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	122300000X	Dentist	42389	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B-4289-01	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1528238235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE LUIS OSORIA D.D.S.

Provider Business Mailing Address
First Line	:	1155 W CENTRAL AVE
Second Line	:	SUITE #201
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3165
Country	:	US
Telephone Number	:	714-546-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 WEST CENTRAL AVE.
Second Line	:	SUITE 201
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3153
Country	:	US
Telephone Number	:	714-546-6488
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSE LUIS OSORIA
Credential	:	DDS
Telephone Number	:	714-546-6488

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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