Basic Information
| Provider Information | |||||||||
| NPI: | 1760428072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | THERESE | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5451 E LAS LOMAS ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908154138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624985988 | ||||||||
| FaxNumber: | 5628265765 | ||||||||
| Practice Location | |||||||||
| Address1: | 3505 CADILLAC AVE | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926261429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149795680 | ||||||||
| FaxNumber: | 7146689341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 298467 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.