Provider Demographics
NPI:1871707083
Name:OSMA, AMALIA SERASPI (DMD)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:SERASPI
Last Name:OSMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 COMMUNITY ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4221
Mailing Address - Country:US
Mailing Address - Phone:818-268-0178
Mailing Address - Fax:
Practice Address - Street 1:510 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3737
Practice Address - Country:US
Practice Address - Phone:661-273-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice