Healthcare Provider Details

I. General information

NPI: 1841151602
Provider Name (Legal Business Name): YAZJI PEDIATRIC CARE, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81833 DR CARREON BLVD STE 6
INDIO CA
92201-5590
US

IV. Provider business mailing address

81833 DR CARREON BLVD STE 6
INDIO CA
92201-5590
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-7763
  • Fax: 760-775-9953
Mailing address:
  • Phone: 760-775-7763
  • Fax: 760-775-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANAS AL YAZJI
Title or Position: CEO
Credential: MD
Phone: 904-338-1004