Provider Demographics
NPI:1437105657
Name:YOUNG, DELORES J (RNC, NP)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 FLORIDA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4400
Mailing Address - Country:US
Mailing Address - Phone:209-524-1264
Mailing Address - Fax:
Practice Address - Street 1:1444 FLORIDA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4400
Practice Address - Country:US
Practice Address - Phone:209-524-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208895363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5238OtherREG NURSING FURNISHING #