Healthcare Provider Details

I. General information

NPI: 1689063273
Provider Name (Legal Business Name): SARAH YOUNG DEJESUS N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3762 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

IV. Provider business mailing address

3762 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

V. Phone/Fax

Practice location:
  • Phone: 949-414-7246
  • Fax: 949-757-3846
Mailing address:
  • Phone: 949-414-7246
  • Fax: 949-757-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: