Healthcare Provider Details

I. General information

NPI: 1316696206
Provider Name (Legal Business Name): ELIZABETH VICTORIA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DRIVE MC 8425
SAN DIEGO CA
92103
US

IV. Provider business mailing address

200 W ARBOR DRIVE MC 8425
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6268
  • Fax:
Mailing address:
  • Phone: 619-543-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number187657
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number187657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: