Healthcare Provider Details

I. General information

NPI: 1023030178
Provider Name (Legal Business Name): LIESL G YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL CIR #120
CENTENNIAL CO
80112-7200
US

IV. Provider business mailing address

9094 E MINERAL CIR #120
CENTENNIAL CO
80112-7200
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-5437
  • Fax: 303-689-9628
Mailing address:
  • Phone: 303-779-5437
  • Fax: 303-689-9628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38578
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: