Healthcare Provider Details

I. General information

NPI: 1982344206
Provider Name (Legal Business Name): KHARL ANTHONY WRIGHT II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

27431 SAN BERNARDINO AVE APT 78
REDLANDS CA
92374-5078
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6688
  • Fax:
Mailing address:
  • Phone: 954-665-9263
  • 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: