1659681708 NPI number — AMY ELIZABETH WRIGHT

Table of content: AMY ELIZABETH WRIGHT (NPI 1659681708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659681708 NPI number — AMY ELIZABETH WRIGHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
AMY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659681708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 WEST 10TH STREET, SPACE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILROY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-476-0539
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 SAN BENITO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLISTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95023-4899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-636-2121
Provider Business Practice Location Address Fax Number:
408-254-9960
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  51989 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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