Healthcare Provider Details

I. General information

NPI: 1376428151
Provider Name (Legal Business Name): JONATHAN WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 CENTER ST STE 200
BERKELEY CA
94704-1386
US

IV. Provider business mailing address

2727 COLLEGE AVE
BERKELEY CA
94705-1247
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8283
  • Fax:
Mailing address:
  • Phone: 510-332-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: