=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538248323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICARDO B. YOUNG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 09/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 H ST STE C-1
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-544-2554
-----------------------------------------------------
Fax | 209-544-2595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12900 PARK PLAZA DR STE 150
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-9329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-977-4674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A76149
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------