MEDICARE: JESSICA RUTH YOUNG DVM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian	14797	CA

General Provider Information

NPI Number	:	1215244827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RUTH YOUNG DVM

Provider Business Mailing Address
First Line	:	4299 E RAMON RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1422
Country	:	US
Telephone Number	:	760-778-9999
Fax Number	:	760-778-9979

Provider Business Practice Location Address
First Line	:	4299 E RAMON RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1422
Country	:	US
Telephone Number	:	760-778-9999
Fax Number	:	760-778-9979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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