Provider Demographics
NPI:1053550319
Name:OSBORNE, MICHAEL (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 VIOLA PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2725
Mailing Address - Country:US
Mailing Address - Phone:949-278-5671
Mailing Address - Fax:
Practice Address - Street 1:1824 VIOLA PL UNIT B
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2725
Practice Address - Country:US
Practice Address - Phone:949-278-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF657982471Q0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471Q0001XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistQuality Management