Provider Demographics
NPI:1194964106
Name:WRIGHT, GLENN HOWARD (BA RAS)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:HOWARD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:BA RAS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2717 ARROW HWY
Mailing Address - Street 2:SPACE 30
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5668
Mailing Address - Country:US
Mailing Address - Phone:909-593-5761
Mailing Address - Fax:
Practice Address - Street 1:1517 W GARVEY AVE N
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2138
Practice Address - Country:US
Practice Address - Phone:626-962-6061
Practice Address - Fax:626-962-4471
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator