Healthcare Provider Details

I. General information

NPI: 1306926639
Provider Name (Legal Business Name): YOUNG PEARL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0688
  • Fax: 562-402-3032
Mailing address:
  • Phone: 562-402-0688
  • Fax: 562-402-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number408216
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: