Provider Demographics
NPI:1700202983
Name:WRIGHT, JENNIFER PAYAD (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAYAD
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14238 VIA MICHELANGELO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4200
Mailing Address - Country:US
Mailing Address - Phone:858-254-0562
Mailing Address - Fax:
Practice Address - Street 1:12396 WORLD TRADE DR
Practice Address - Street 2:#106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3786
Practice Address - Country:US
Practice Address - Phone:858-385-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430325163W00000X
CA11646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse