Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A84751 | CA |
NPI | 1043368053 |
---|---|
Provider Name | Lisa M. Young |
First Address | Harbor City, CA 90710-3518 |
Second Address | Harbor City, CA 90710-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 23/09/2008 |