Healthcare Provider Details

I. General information

NPI: 1982604047
Provider Name (Legal Business Name): JEFFREY MICHAEL YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

IV. Provider business mailing address

1080 EMELINE AVE CLINIC ADMIN
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4100
  • Fax: 831-454-5001
Mailing address:
  • Phone: 831-454-4100
  • Fax: 831-454-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG52682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: