Healthcare Provider Details

I. General information

NPI: 1245459676
Provider Name (Legal Business Name): ADAM WREN C.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WEST HOSPITAL RD
FRENCH CAMP CA
95231
US

IV. Provider business mailing address

PO BOX 1020
STOCKTON CA
95201-3120
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6937
  • Fax: 209-468-7042
Mailing address:
  • Phone: 209-468-6937
  • Fax: 209-468-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number26054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: