Provider Demographics
NPI:1033398136
Name:EDGARDO A OSEA M D INC
Entity Type:Organization
Organization Name:EDGARDO A OSEA M D INC
Other - Org Name:HOLY TRINITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:OSEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-534-5765
Mailing Address - Street 1:1310 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1156
Mailing Address - Country:US
Mailing Address - Phone:310-534-5765
Mailing Address - Fax:310-534-5913
Practice Address - Street 1:1310 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1156
Practice Address - Country:US
Practice Address - Phone:310-534-5765
Practice Address - Fax:310-534-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44654261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17706Medicare UPIN
WA44654BMedicare PIN
W11878Medicare PIN