Provider Demographics
NPI:1043870348
Name:OSBORNE HEAD AND NECK SPECIALTY GROUP
Entity type:Organization
Organization Name:OSBORNE HEAD AND NECK SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-657-0123
Mailing Address - Street 1:8631 W 3RD ST STE 945E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5912
Mailing Address - Country:US
Mailing Address - Phone:310-657-0123
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST STE 945E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5912
Practice Address - Country:US
Practice Address - Phone:310-657-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty