Provider Demographics
NPI:1417191271
Name:OSHIMA, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:OSHIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 N LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3134
Mailing Address - Country:US
Mailing Address - Phone:909-608-7721
Mailing Address - Fax:909-694-1181
Practice Address - Street 1:1349 N LAUREL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3134
Practice Address - Country:US
Practice Address - Phone:909-608-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility