Healthcare Provider Details

I. General information

NPI: 1306148879
Provider Name (Legal Business Name): QUINTON TYLER YOUNG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/19/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 N. WHITNEY AVENUE SUITE #101
FRESNO CA
93720-8002
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-7338
  • Fax:
Mailing address:
  • Phone: 559-228-4200
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A11507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: