Provider Demographics
NPI:1518371533
Name:YOUNG, SIERRA RAYNE (BS)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:RAYNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 IRVING ST
Mailing Address - Street 2:STE # 206A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2747
Mailing Address - Country:US
Mailing Address - Phone:707-363-8248
Mailing Address - Fax:
Practice Address - Street 1:145 IRVING ST
Practice Address - Street 2:STE # 206A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2747
Practice Address - Country:US
Practice Address - Phone:707-363-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program