Basic Information
| Provider Information | |||||||||
| NPI: | 1336816149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | GLORIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5415 HILTON AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPLE CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917803123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262248768 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14659 OLIVE VIEW DR | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913421652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184850888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2021 | ||||||||
| LastUpdateDate: | 08/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 95203767 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.