Basic Information
| Provider Information | |||||||||
| NPI: | 1093272668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSORIO | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1117 W 14TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511032909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122125297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 625 COURT ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122523871 | ||||||||
| FaxNumber: | 7122523157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2019 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A130250 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364SP0808X | G163096 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.