Provider Demographics
NPI:1275085060
Name:OSBURN, SOPHIA (LAC)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:
Last Name:OSBURN
Suffix:
Gender:F
Credentials:LAC
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 3212
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2212
Mailing Address - Country:US
Mailing Address - Phone:562-888-4998
Mailing Address - Fax:
Practice Address - Street 1:550 PACIFIC COAST HWY STE 207
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6657
Practice Address - Country:US
Practice Address - Phone:562-888-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist