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NPI Code Detail

MEDICARE: DENISE WAGNER MS, BS

MEDICARE: DENISE WAGNER MS, BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3171400000XHealth & Wellness Coach

General Provider Information

NPI Number : 1174730972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE WAGNER MS, BS
Provider Business Mailing Address
First Line : 30141 ANTELOPE RD STE D726
Second Line :
City : MENIFEE
State : CA
Zip : 92584-7001
Country : US
Telephone Number : 196-318-6116
Fax Number :
Provider Business Practice Location Address
First Line : 29650 BRADLEY RD STE B
Second Line :
City : MENIFEE
State : CA
Zip : 92586-6521
Country : US
Telephone Number : 951-430-9247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 06/12/2023

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