Provider Demographics
NPI:1114483260
Name:YOUNG, MELLIZA
Entity Type:Individual
Prefix:
First Name:MELLIZA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHALAN BALAKO PMB 821
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-7103
Mailing Address - Country:US
Mailing Address - Phone:671-787-6640
Mailing Address - Fax:
Practice Address - Street 1:219 S MARINE CORPS DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3927
Practice Address - Country:US
Practice Address - Phone:671-646-6956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator