Healthcare Provider Details

I. General information

NPI: 1407673130
Provider Name (Legal Business Name): CHLOE MAE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 AERO DR
SAN DIEGO CA
92123-1776
US

IV. Provider business mailing address

8755 AERO DR
SAN DIEGO CA
92123-1776
US

V. Phone/Fax

Practice location:
  • Phone: 619-615-0701
  • Fax:
Mailing address:
  • Phone: 619-615-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: