Provider Demographics
NPI:1194162073
Name:OSSORIO, ROBERT CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLIFFORD
Last Name:OSSORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 CRISP CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4601
Mailing Address - Country:US
Mailing Address - Phone:818-906-9508
Mailing Address - Fax:
Practice Address - Street 1:4144 CRISP CANYON RD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4601
Practice Address - Country:US
Practice Address - Phone:818-906-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist