Healthcare Provider Details

I. General information

NPI: 1235956905
Provider Name (Legal Business Name): VERONICA HOPE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24028 LAKE DR
CRESTLINE CA
92352
US

IV. Provider business mailing address

24028 LAKE DR, STE A
CRESTLINE CA
92325
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-3222
  • Fax:
Mailing address:
  • Phone: 909-338-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: