Provider Demographics
NPI:1073969176
Name:WRIGHT, JAIME ROXANN
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ROXANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13636 VENTURA BLVD
Mailing Address - Street 2:369
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3700
Mailing Address - Country:US
Mailing Address - Phone:213-605-0992
Mailing Address - Fax:
Practice Address - Street 1:13636 VENTURA BLVD
Practice Address - Street 2:369
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3700
Practice Address - Country:US
Practice Address - Phone:213-605-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner