Provider Demographics
NPI:1669058178
Name:WEXLER, ANTONY CHARLES
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:CHARLES
Last Name:WEXLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:WEXLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1922 THE ALAMEDA STE 316
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1461
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-248-6520
Practice Address - Street 1:2001 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1136
Practice Address - Country:US
Practice Address - Phone:408-461-7777
Practice Address - Fax:408-248-6520
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician