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General NPI Number Information
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NPI Number | 1710419098
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Entity Type | Organization
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Legal Business Name | ANDREA YOUNG DO, INC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 1 PRINCESS ST
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City | SAUSALITO
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State | CA
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Zip | 94965-2209
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Country | US
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Telephone | 415-480-4707
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Fax |
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Provider Business Mailing Address
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Address Line | 445 SAUSALITO BLVD
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City | SAUSALITO
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State | CA
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Zip | 94965-2333
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Country | US
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Telephone | 415-480-4707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ANDREA N YOUNG
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Credential | DO
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Telephone | 415-480-4707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A12045
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License Number State | CA
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