Provider Demographics
NPI:1508642190
Name:OSORIO, OBDULIA
Entity Type:Individual
Prefix:
First Name:OBDULIA
Middle Name:
Last Name:OSORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 CRESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1310
Mailing Address - Country:US
Mailing Address - Phone:240-459-4544
Mailing Address - Fax:
Practice Address - Street 1:5706 CRESTWOOD PL
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1310
Practice Address - Country:US
Practice Address - Phone:240-459-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant