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General NPI Number Information
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NPI Number | 1235443342
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Entity Type | Organization
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Legal Business Name | THE VILLAGE FAMILY DOCTOR
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 207 BRIDGE ST
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3311
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Country | US
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Telephone | 805-481-1975
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Fax | 866-481-4145
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Provider Business Mailing Address
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Address Line | 207 BRIDGE ST
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3311
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Country | US
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Telephone | 805-481-1975
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Fax | 866-481-4145
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Authorized Official
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Title or Position | OWNER
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Name | DR. KARIN YOUNG
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Credential | M.D.
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Telephone | 805-481-1975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A77911
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License Number State | CA
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