Healthcare Provider Details

I. General information

NPI: 1245401272
Provider Name (Legal Business Name): RANDALL S YOUNG C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26440 LA ALAMEDA SUITE 320
MISSION VIEJO CA
92691-6304
US

IV. Provider business mailing address

7720 CARDINAL CT
SAN DIEGO CA
92123-3333
US

V. Phone/Fax

Practice location:
  • Phone: 949-367-6600
  • Fax: 949-367-6617
Mailing address:
  • Phone: 858-292-7449
  • Fax: 858-292-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: