Provider Demographics
NPI:1568665362
Name:WRIGHT, GREGORY SCOTT (CRNA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2561
Mailing Address - Country:US
Mailing Address - Phone:818-317-6909
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2561
Practice Address - Country:US
Practice Address - Phone:818-317-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA1954367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN3751600Medicaid
CAP08419Medicare UPIN
CARN3751600Medicaid