Provider Demographics
NPI:1831087477
Name:OSORIO, KIMBERLY ISABEL (AA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ISABEL
Last Name:OSORIO
Suffix:
Gender:X
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 W 156TH ST SPC 43
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3541
Mailing Address - Country:US
Mailing Address - Phone:323-272-1471
Mailing Address - Fax:
Practice Address - Street 1:1911 W 156TH ST SPC 43
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3541
Practice Address - Country:US
Practice Address - Phone:310-590-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician