Provider Demographics
NPI:1689063273
Name:DEJESUS, SARAH YOUNG (NP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:YOUNG
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1523
Mailing Address - Country:US
Mailing Address - Phone:909-643-4781
Mailing Address - Fax:
Practice Address - Street 1:220 LAGUNA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2523
Practice Address - Country:US
Practice Address - Phone:909-643-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner