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NPI Code Detail

MEDICARE: NICOLE YOUNG PSY.D.

MEDICARE: NICOLE YOUNG PSY.D.
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
1103TC0700XClinical PsychologistPSY25364CA

General Provider Information

NPI Number : 1992991079
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE YOUNG PSY.D.
Provider Business Mailing Address
First Line : 11650 IBERIA PLACE
Second Line : #130
City : SAN DIEGO
State : CA
Zip : 92128
Country : US
Telephone Number : 801-935-4171
Fax Number :
Provider Business Practice Location Address
First Line : 11650 IBERIA PL STE 130
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-2431
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2007
Last Update Date : 03/17/2018

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Directions to “ NICOLE YOUNG PSY.D.” Practice Location

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