Provider Demographics
NPI:1720180565
Name:YOUNG, CARROLL MARK
Entity Type:Individual
Prefix:MRS
First Name:CARROLL
Middle Name:MARK
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CARROLL
Other - Middle Name:T
Other - Last Name:MARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8747 CLIFFRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2115
Mailing Address - Country:US
Mailing Address - Phone:858-452-0895
Mailing Address - Fax:858-450-3680
Practice Address - Street 1:4150 REGENTS PARK ROW SUITE 365
Practice Address - Street 2:UCSD ORTHOPAEDIC HAND THERAPY
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2115
Practice Address - Country:US
Practice Address - Phone:858-657-8177
Practice Address - Fax:858-657-8269
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand