Provider Demographics
NPI:1073764791
Name:OSORIA, GUILLERMINA (LICENSED INSURANCE,)
Entity Type:Individual
Prefix:MS
First Name:GUILLERMINA
Middle Name:
Last Name:OSORIA
Suffix:
Gender:F
Credentials:LICENSED INSURANCE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S RIVERSIDE DR STE G
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3394
Mailing Address - Country:US
Mailing Address - Phone:505-753-3512
Mailing Address - Fax:888-504-0115
Practice Address - Street 1:424 S RIVERSIDE DR STE G
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3394
Practice Address - Country:US
Practice Address - Phone:505-595-4848
Practice Address - Fax:888-504-0115
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171400000X, 174N00000X, 175T00000X, 172V00000X
171R00000X, 174H00000X
GA053063484172A00000X
GACN0028898365376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175T00000XOther Service ProvidersPeer Specialist
No376K00000XNursing Service Related ProvidersNurse's Aide