Provider Demographics
NPI:1679169841
Name:OSANU, FLORINEL (ADMINISTRATOR,)
Entity Type:Individual
Prefix:
First Name:FLORINEL
Middle Name:
Last Name:OSANU
Suffix:
Gender:M
Credentials:ADMINISTRATOR,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-2612
Mailing Address - Country:US
Mailing Address - Phone:916-532-9029
Mailing Address - Fax:916-652-2309
Practice Address - Street 1:8510 ELM AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-2612
Practice Address - Country:US
Practice Address - Phone:916-532-9029
Practice Address - Fax:916-652-2309
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001619310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility