Provider Demographics
NPI:1558594267
Name:YOUNG, PETER GEOFFREY
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GEOFFREY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 LAKESHORE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1222
Mailing Address - Country:US
Mailing Address - Phone:510-735-6196
Mailing Address - Fax:
Practice Address - Street 1:480 MANOR PLZ
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1839
Practice Address - Country:US
Practice Address - Phone:650-591-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program