Provider Demographics
NPI:1487989372
Name:OSMAN, SOSIAN A
Entity type:Individual
Prefix:
First Name:SOSIAN
Middle Name:A
Last Name:OSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 E BRIARWOOD TER
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0152
Mailing Address - Country:US
Mailing Address - Phone:602-277-5944
Mailing Address - Fax:602-277-5878
Practice Address - Street 1:4724 E. BRIARWOOD TER
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0152
Practice Address - Country:US
Practice Address - Phone:602-277-5944
Practice Address - Fax:602-277-5878
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ141150-5172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ299640Medicaid