Healthcare Provider Details

I. General information

NPI: 1033410303
Provider Name (Legal Business Name): CARMEN YOUNG LUNG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 DELTA LN
ARCADIA CA
91007-8209
US

IV. Provider business mailing address

164 DELTA LN
ARCADIA CA
91007-8209
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-9356
  • Fax:
Mailing address:
  • Phone: 626-254-9356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNMW1914
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number20279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: