Provider Demographics
NPI:1659487817
Name:YOUNG, ROSABEL R (MD, MS PHARM)
Entity Type:Individual
Prefix:
First Name:ROSABEL
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD, MS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9536
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-2736
Mailing Address - Country:US
Mailing Address - Phone:909-557-8727
Mailing Address - Fax:909-335-8514
Practice Address - Street 1:16 E FERN AVE STE D
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:310-680-0304
Practice Address - Fax:310-680-0305
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA988230202C00000X, 209800000X
CAG641572084N0400X, 208U00000X, 2084N0600X
IL7622084N0600X
IL0376072084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G641570OtherBLUE SHIELD
CA180519600OtherOWCP
CAP00011946OtherRAILROAD MEDICARE
CA00G641570Medicaid
CAG64157Medicare PIN
CABK279ZMedicare PIN
CA00G641570OtherBLUE SHIELD
CAF22782Medicare UPIN
CA00G641570Medicare PIN