Provider Demographics
NPI:1265423750
Name:WRIGHT, HERBERT STEPHEN (PA)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:STEPHEN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N EL CIELO RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6972
Mailing Address - Country:US
Mailing Address - Phone:760-320-8814
Mailing Address - Fax:760-320-2725
Practice Address - Street 1:41120 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9215
Practice Address - Country:US
Practice Address - Phone:760-360-3193
Practice Address - Fax:760-320-2725
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA129780Medicare ID - Type Unspecified
CAS21926Medicare UPIN