Healthcare Provider Details

I. General information

NPI: 1699608364
Provider Name (Legal Business Name): CLYDEISHA YOUNGER CPT 1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 W TEXAS ST STE 121
FAIRFIELD CA
94533-5952
US

IV. Provider business mailing address

1652 W TEXAS ST STE 121
FAIRFIELD CA
94533-5952
US

V. Phone/Fax

Practice location:
  • Phone: 916-915-4669
  • Fax:
Mailing address:
  • Phone: 916-915-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-02287545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: