Healthcare Provider Details

I. General information

NPI: 1740149053
Provider Name (Legal Business Name): JASON YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81557 DR CARREON BLVD STE C9
INDIO CA
92201-5562
US

IV. Provider business mailing address

81557 DR CARREON BLVD STE C9
INDIO CA
92201-5562
US

V. Phone/Fax

Practice location:
  • Phone: 760-391-6999
  • Fax:
Mailing address:
  • Phone: 760-391-6999
  • Fax: 760-391-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DGIJHE
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: