Healthcare Provider Details

I. General information

NPI: 1538248323
Provider Name (Legal Business Name): RICARDO B. YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 H ST STE C-1
MODESTO CA
95354-1221
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 209-544-2554
  • Fax: 209-544-2595
Mailing address:
  • Phone: 562-977-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: