MEDICARE: CLYDEISHA YOUNGER CPT 1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	CPT-02287545	CA

General Provider Information

NPI Number	:	1699608364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDEISHA YOUNGER CPT 1

Provider Business Mailing Address
First Line	:	1652 W TEXAS ST STE 121
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5952
Country	:	US
Telephone Number	:	916-915-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1652 W TEXAS ST STE 121
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5952
Country	:	US
Telephone Number	:	916-915-4669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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