Healthcare Provider Details

I. General information

NPI: 1548871437
Provider Name (Legal Business Name): NAOMI MAE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2461 WARRING ST APT 211
BERKELEY CA
94704-2561
US

IV. Provider business mailing address

2461 WARRING ST APT 211
BERKELEY CA
94704-2561
US

V. Phone/Fax

Practice location:
  • Phone: 619-302-7496
  • Fax:
Mailing address:
  • Phone:
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: