Provider Demographics
NPI:1477094514
Name:YOUNG, BLYSS (LM, CPM)
Entity Type:Individual
Prefix:
First Name:BLYSS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N LA PATERA LN
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1509
Mailing Address - Country:US
Mailing Address - Phone:310-663-3706
Mailing Address - Fax:
Practice Address - Street 1:405 N LA PATERA LN
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1509
Practice Address - Country:US
Practice Address - Phone:310-663-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM485176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife