Healthcare Provider Details

I. General information

NPI: 1992591754
Provider Name (Legal Business Name): MAURICE DEDRIC WRIGHT II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

IV. Provider business mailing address

1326 OAKWOOD DR
MODESTO CA
95350-4849
US

V. Phone/Fax

Practice location:
  • Phone: 209-702-0139
  • Fax:
Mailing address:
  • Phone: 209-809-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: