Healthcare Provider Details

I. General information

NPI: 1285046342
Provider Name (Legal Business Name): CARL WRIGHT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 NEWBERRY DR STE 100
SAN JOSE CA
95118-1565
US

IV. Provider business mailing address

1671 HAMILTON AVE APT 36
SAN JOSE CA
95125-5407
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-0550
  • Fax: 408-266-0124
Mailing address:
  • Phone: 408-449-1921
  • Fax: 408-266-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: