Provider Demographics
NPI:1508012873
Name:YOUNG, ROBERT OLDHAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OLDHAM
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16390 DIA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6025
Mailing Address - Country:US
Mailing Address - Phone:760-751-8321
Mailing Address - Fax:760-751-8324
Practice Address - Street 1:16390 DIA DEL SOL
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6025
Practice Address - Country:US
Practice Address - Phone:760-751-8321
Practice Address - Fax:760-751-8324
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist