Provider Demographics
NPI:1891065793
Name:YOUNG, HAVEN ALLAN (LP)
Entity Type:Individual
Prefix:MR
First Name:HAVEN
Middle Name:ALLAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S FLORES ST
Mailing Address - Street 2:308
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1655
Mailing Address - Country:US
Mailing Address - Phone:210-247-7246
Mailing Address - Fax:
Practice Address - Street 1:1331 S FLORES ST
Practice Address - Street 2:308
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1655
Practice Address - Country:US
Practice Address - Phone:210-247-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0246242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist