Provider Demographics
NPI:1578198347
Name:YOUNG, ALESSANDRA R (LAC MTOM)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LAC MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 COLDWATER CANYON AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1083
Mailing Address - Country:US
Mailing Address - Phone:323-301-8791
Mailing Address - Fax:
Practice Address - Street 1:441 S BEVERLY DR STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4427
Practice Address - Country:US
Practice Address - Phone:310-425-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172853171100000X
CA18817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18817OtherCALIFORNIA ACUPUNCTURE BOARD