Healthcare Provider Details

I. General information

NPI: 1245692748
Provider Name (Legal Business Name): ELIZABETH PEALE YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 4
SAN FRANCISCO CA
94158-2545
US

IV. Provider business mailing address

550 16TH ST FL 4
SAN FRANCISCO CA
94158-2545
US

V. Phone/Fax

Practice location:
  • Phone: 713-907-7508
  • Fax:
Mailing address:
  • Phone: 713-907-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA161460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: