Healthcare Provider Details

I. General information

NPI: 1770099152
Provider Name (Legal Business Name): CYNTHIA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4786 BANNISTER AVE
EL MONTE CA
91732-1710
US

IV. Provider business mailing address

4786 BANNISTER AVE
EL MONTE CA
91732-1710
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: