Provider Demographics
NPI:1932159225
Name:OSORIO, SYLVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:OSORIO
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 1:4161 REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3340
Mailing Address - Country:US
Mailing Address - Phone:310-214-8677
Mailing Address - Fax:310-921-1718
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-352-4170
Practice Address - Fax:310-324-7956
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO0254829OtherDEA NUMBER
CAE95549Medicare UPIN
CAWG56557FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER