Provider Demographics
NPI:1447461272
Name:WRIGHT, TABITA A (MD)
Entity type:Individual
Prefix:DR
First Name:TABITA
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:951-925-3606
Practice Address - Street 1:850 E LATHAM AVE
Practice Address - Street 2:101
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4391
Practice Address - Country:US
Practice Address - Phone:951-929-9688
Practice Address - Fax:951-766-1269
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG585862085R0202X
MA2336952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology