Healthcare Provider Details

I. General information

NPI: 1871776484
Provider Name (Legal Business Name): CLARENCE YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 ARLINGTON AVE STE C
RIVERSIDE CA
92504
US

IV. Provider business mailing address

6711 ARLINGTON AVE STE C
RIVERSIDE CA
92504-1966
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: