Provider Demographics
NPI:1386200418
Name:YOUNG, ROCHELLE AMELIA (RDLDN)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:AMELIA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDLDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73043 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5917
Mailing Address - Country:US
Mailing Address - Phone:985-705-6738
Mailing Address - Fax:
Practice Address - Street 1:23180 HEMLOCK AVE STE 201
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8001
Practice Address - Country:US
Practice Address - Phone:951-243-6460
Practice Address - Fax:951-243-5871
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2860133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86083909OtherCOMMISSION ON DIETETIC REGISTRATION
LA2860OtherLOUISIANA BOARD OF EXAMINERS OF DIETETIC & NUTRITION
LA86083909OtherCOMMISSION ON DIETETIC REGISTRATION