Provider Demographics
NPI:1992880439
Name:OSBORNE, RYAN F (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:F
Last Name:OSBORNE
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:PO BOX 451400
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8515
Mailing Address - Country:US
Mailing Address - Phone:310-657-0123
Mailing Address - Fax:310-657-0142
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 945E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-657-0123
Practice Address - Fax:310-657-0142
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64640207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646400Medicaid
CAH38785Medicare UPIN
CA00A646400Medicaid