Provider Demographics
NPI:1740010677
Name:WRIGHT, BRYSON A
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:A
Last Name:WRIGHT
Suffix:
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 1:1724 CORTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6513
Mailing Address - Country:US
Mailing Address - Phone:925-586-9512
Mailing Address - Fax:925-420-5886
Practice Address - Street 1:1724 CORTE VISTA ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6513
Practice Address - Country:US
Practice Address - Phone:925-586-9512
Practice Address - Fax:925-420-5886
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA075601562310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility