Healthcare Provider Details

I. General information

NPI: 1902076003
Provider Name (Legal Business Name): DAVID WREN, JR., M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BROADWAY SUITE 21
RICHMOND CA
94804-1938
US

IV. Provider business mailing address

120 BROADWAY SUITE 21
RICHMOND CA
94804-1938
US

V. Phone/Fax

Practice location:
  • Phone: 510-235-9014
  • Fax: 510-232-1411
Mailing address:
  • Phone: 510-235-9014
  • Fax: 510-232-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG22810
License Number StateCA

VIII. Authorized Official

Name: DAVID WREN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-235-9014