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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Susan Lillian Osova | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| First name | Susan | [sources] | |||
| Last name | Osova | [sources] | |||
| Middle name | Lillian | [sources] | |||
| Registration number | 74655 | [sources] | |||
| Sector | Physician | [sources] | |||
| Address | 1081 North China Lake Blvd., Ridgecrest, CA · 310 Esplanade Ave., Unit #59, Pacifica, CA · 3303 Harbor Blvd., Unit D11, Costa Mesa, CA | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States of America · DHCS
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Department of Health Care Services | - | |||