Provider Demographics
NPI:1013410679
Name:YOUNG, DEMAR (MED/ CAMF/CDVF)
Entity Type:Individual
Prefix:MR
First Name:DEMAR
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MED/ CAMF/CDVF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43537 RIDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3615
Mailing Address - Country:US
Mailing Address - Phone:623-202-8810
Mailing Address - Fax:
Practice Address - Street 1:43537 RIDGE PARK DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3615
Practice Address - Country:US
Practice Address - Phone:623-202-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB7138627OtherDRIVERS LICENSE