Provider Demographics
NPI:1790940435
Name:OSPINA, MYRIAM
Entity Type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:
Last Name:OSPINA
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 1:1319 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2927
Mailing Address - Country:US
Mailing Address - Phone:510-535-2303
Mailing Address - Fax:510-535-2346
Practice Address - Street 1:1315 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2927
Practice Address - Country:US
Practice Address - Phone:510-536-4760
Practice Address - Fax:510-535-6132
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor