Provider Demographics
NPI:1285765537
Name:YOUNG, ROSALYN CAROL
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:CAROL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:CAROL
Other - Last Name:YOUNG-BOWIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8163 REDLANDS ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8615
Mailing Address - Country:US
Mailing Address - Phone:310-822-3701
Mailing Address - Fax:323-293-9459
Practice Address - Street 1:6305 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2346
Practice Address - Country:US
Practice Address - Phone:818-909-3380
Practice Address - Fax:818-909-3383
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner