Provider Demographics
NPI:1740917574
Name:JORGE DE LA OSA DDS INCORPORATED
Entity type:Organization
Organization Name:JORGE DE LA OSA DDS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:XOCHITL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-672-0884
Mailing Address - Street 1:11629 LOWER AZUSA RD STE H
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1389
Mailing Address - Country:US
Mailing Address - Phone:626-672-0224
Mailing Address - Fax:
Practice Address - Street 1:11629 LOWER AZUSA RD STE H
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-1389
Practice Address - Country:US
Practice Address - Phone:626-672-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336186618Medicaid
CA54134Medicaid