Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1961 | CA |
Y | 222Z00000X | Podiatrist | E1961 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E1961 | CA |
NPI | 1093968117 |
---|---|
Provider Name | Barry Young |
First Address | Loma Linda, CA 92354-1069 |
Second Address | Loma Linda, CA 92354-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 03/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E1961 | BOARD OF PODIATRIC MEDICINE (01) | CA |