Provider Demographics
NPI:1689030512
Name:OSITL, LORETA DE LUNA (CNA)
Entity Type:Individual
Prefix:MISS
First Name:LORETA
Middle Name:DE LUNA
Last Name:OSITL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 STARWARD DR.
Mailing Address - Street 2:55
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1861
Mailing Address - Country:US
Mailing Address - Phone:510-760-7130
Mailing Address - Fax:800-714-1970
Practice Address - Street 1:7315 STARWARD DR.
Practice Address - Street 2:55
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1861
Practice Address - Country:US
Practice Address - Phone:510-760-7130
Practice Address - Fax:800-714-1970
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00290581376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL109529OtherCITY OF DUBLIN BUSINESS LICENSE