Healthcare Provider Details

I. General information

NPI: 1205340973
Provider Name (Legal Business Name): NICOLE WRIGHT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S PASEO DOROTEA STE 4A
PALM SPRINGS CA
92264-1434
US

IV. Provider business mailing address

5630 E SANTA ANA CANYON RD
ANAHEIM CA
92807-3122
US

V. Phone/Fax

Practice location:
  • Phone: 951-297-8375
  • Fax: 951-602-8264
Mailing address:
  • Phone: 714-257-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: