Provider Demographics
NPI:1336168418
Name:ANCONA YOUNG, CORINNE JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:JEAN
Last Name:ANCONA YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3187
Mailing Address - Country:US
Mailing Address - Phone:619-270-4388
Mailing Address - Fax:619-937-3767
Practice Address - Street 1:8881 FLETCHER PKWY STE 205
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3187
Practice Address - Country:US
Practice Address - Phone:619-270-4388
Practice Address - Fax:619-937-3767
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2428935Medicaid
H81301Medicare UPIN