Healthcare Provider Details

I. General information

NPI: 1386200418
Provider Name (Legal Business Name): ROCHELLE AMELIA YOUNG RD.LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23180 HEMLOCK AVE STE 201
MORENO VALLEY CA
92557-8001
US

IV. Provider business mailing address

73043 PLANTATION ST
COVINGTON LA
70435-5917
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-6460
  • Fax: 951-243-5871
Mailing address:
  • Phone: 985-705-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number2860
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2860
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: