Provider Demographics
NPI:1295300580
Name:WRIGHT, ANTHONY ROBLES
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROBLES
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 1:1244 TRES LOMAS DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5121
Mailing Address - Country:US
Mailing Address - Phone:619-873-5086
Mailing Address - Fax:
Practice Address - Street 1:1244 TRES LOMAS DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5121
Practice Address - Country:US
Practice Address - Phone:619-873-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00367702390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program