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General NPI Number Information
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NPI Number | 1861008013
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Entity Type | Organization
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Legal Business Name | NEW 2 YOU SKIN & BODY
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 1615 HILL RD STE J
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City | NOVATO
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State | CA
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Zip | 94947-4338
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Country | US
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Telephone | 415-895-1441
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Fax | 415-895-1288
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Provider Business Mailing Address
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Address Line | 1615 HILL RD STE J
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City | NOVATO
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State | CA
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Zip | 94947-4338
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Country | US
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Telephone | 415-895-1441
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Fax | 415-895-1288
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS P YOUNG
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Credential | PHD NP
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Telephone | 415-895-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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