Provider Demographics
NPI:1427446335
Name:OSBORNE, ANA S
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:S
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 LA TIERRA DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4613
Mailing Address - Country:US
Mailing Address - Phone:760-522-1989
Mailing Address - Fax:760-304-4685
Practice Address - Street 1:2690 MARY LANE PL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7754
Practice Address - Country:US
Practice Address - Phone:760-233-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374600949310400000X
CA374602712310400000X
CA374600462310400000X
CA374602047310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility