Provider Demographics
NPI:1285046342
Name:WRIGHT, CARL JR
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 HAMILTON AVE APT 36
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5407
Mailing Address - Country:US
Mailing Address - Phone:408-449-1921
Mailing Address - Fax:408-266-0124
Practice Address - Street 1:3180 NEWBERRY DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1565
Practice Address - Country:US
Practice Address - Phone:408-793-0550
Practice Address - Fax:408-266-0124
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator