Provider Demographics
NPI:1437653185
Name:TRICIA YOUNG RD LLC
Entity Type:Organization
Organization Name:TRICIA YOUNG RD LLC
Other - Org Name:YOUNG WELLNESS & NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:602-752-0619
Mailing Address - Street 1:16815 S DESERT FOOTHILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8401
Mailing Address - Country:US
Mailing Address - Phone:602-752-0619
Mailing Address - Fax:602-883-7226
Practice Address - Street 1:16815 S DESERT FOOTHILLS PKWY STE 134
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8465
Practice Address - Country:US
Practice Address - Phone:602-752-0619
Practice Address - Fax:602-883-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty