Healthcare Provider Details

I. General information

NPI: 1881831527
Provider Name (Legal Business Name): BRETT YOUNG WT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N EL CIELO RD
PALM SPRINGS CA
92262-6972
US

IV. Provider business mailing address

275 N EL CIELO RD
PALM SPRINGS CA
92262-6972
US

V. Phone/Fax

Practice location:
  • Phone: 760-320-4122
  • Fax: 760-323-4823
Mailing address:
  • Phone: 760-320-4122
  • Fax: 760-323-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberAT1219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: