Provider Demographics
NPI:1285047241
Name:OSBORNE, SUSAN A
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11140 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3902
Mailing Address - Country:US
Mailing Address - Phone:310-569-9308
Mailing Address - Fax:
Practice Address - Street 1:11140 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3902
Practice Address - Country:US
Practice Address - Phone:310-569-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator