Provider Demographics
NPI:1538397815
Name:YOUNGBLOOD, VALERIE L (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:L
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 VIA DE LA VALLE
Mailing Address - Street 2:SUITE G143
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1911
Mailing Address - Country:US
Mailing Address - Phone:888-673-6336
Mailing Address - Fax:
Practice Address - Street 1:2683 VIA DE LA VALLE
Practice Address - Street 2:SUITE G143
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1911
Practice Address - Country:US
Practice Address - Phone:888-673-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45502207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538397815Medicaid
CACN479ZMedicare PIN