Healthcare Provider Details

I. General information

NPI: 1487989752
Provider Name (Legal Business Name): PENNY E. YOUNT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10039A VINE ST
LAKESIDE CA
92040-3130
US

IV. Provider business mailing address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

V. Phone/Fax

Practice location:
  • Phone: 619-390-9975
  • Fax: 619-390-8721
Mailing address:
  • Phone: 760-737-6935
  • Fax: 760-741-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN637626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: