Organization
FOOTHILLS NEUROLOGICAL MEDICAL GP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAIL E YOUNG ADMINISTRATOR (ADMINISTRATOR)
(909) 592-2145
Entity
Organization
Contact information
Practice address
1330 W COVINA BLVD, #103, SAN DIMAS, CA 91773-3200
(909) 592-2145
(909) 599-6217
Mailing address
1330 W COVINA BLVD, #103, SAN DIMAS, CA 91773-3200
(909) 592-2145
(909) 599-6217
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
A33406
CA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
A43523
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A334060
—
CA
05
—
00A435230
—
CA
Enumeration date
09/21/2005
Last updated
09/11/2025
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