Provider Demographics
NPI:1134304827
Name:YOUNT, DARYLE R
Entity Type:Individual
Prefix:MR
First Name:DARYLE
Middle Name:R
Last Name:YOUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18317 E COLLIER RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9341
Mailing Address - Country:US
Mailing Address - Phone:209-747-3765
Mailing Address - Fax:
Practice Address - Street 1:18317 E COLLIER RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9341
Practice Address - Country:US
Practice Address - Phone:209-747-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6082OtherCAS