Provider Demographics
NPI:1922172162
Name:OSMENA, MARIA LUISA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:OSMENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 EL CAMINO REAL STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2424
Mailing Address - Country:US
Mailing Address - Phone:650-873-3338
Mailing Address - Fax:650-873-3308
Practice Address - Street 1:1150 EL CAMINO REAL STE 225
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2424
Practice Address - Country:US
Practice Address - Phone:650-873-3338
Practice Address - Fax:650-873-3308
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG78328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101840OtherGROUP MEDICAID #
CA00G783280Medicaid