Provider Demographics
NPI:1528570769
Name:OSORIO, ANA ISABEL
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ISABEL
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 1:15775 MIAMI LAKEWAY N APT 127C
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-8121
Mailing Address - Country:US
Mailing Address - Phone:786-354-3129
Mailing Address - Fax:
Practice Address - Street 1:15775 MIAMI LAKEWAY N APT 127C
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-8121
Practice Address - Country:US
Practice Address - Phone:786-354-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician