Provider Demographics
NPI:1386006062
Name:WIGHT, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:WIGHT
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 1:391 COMPASS RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4641
Mailing Address - Country:US
Mailing Address - Phone:760-576-7501
Mailing Address - Fax:
Practice Address - Street 1:391 COMPASS RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4641
Practice Address - Country:US
Practice Address - Phone:760-576-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator