MEDICARE: MISS KIMBERLY EILEEN WAGNER M.A.

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295938074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY EILEEN WAGNER M.A.

Provider Business Mailing Address
First Line	:	2870 4TH AVE
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6298
Country	:	US
Telephone Number	:	858-997-3457
Fax Number	:	619-297-0470

Provider Business Practice Location Address
First Line	:	2870 4TH AVE
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6298
Country	:	US
Telephone Number	:	858-997-3457
Fax Number	:	619-297-0470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/17/2009

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1790719573 — MRS. LYDIA F. LEWIS M.S.
Practice Location Address:

2870 4TH AVE , SUITE 200
SAN DIEGO, CA
92103-6298

Practice Phone: 619-234-8630
Practice Fax: 619-297-3908

1477604890 — MS. AVA TORRE-BUENO LCSW
Practice Location Address:

2870 4TH AVE
SAN DIEGO, CA
92103-6298

Practice Phone: 619-294-8779
Practice Fax:

1609145358 — MS. LAURA GEORGI DISTEFANO LCSW
Practice Location Address:

2870 4TH AVE , SUITE 200
SAN DIEGO, CA
92103-6298

Practice Phone: 760-492-7333
Practice Fax:

1386086478 — SAN DIEGO PSYCHOLOGY CENTER
Practice Location Address:

2870 4TH AVE , 101
SAN DIEGO, CA
92103-6298

Practice Phone: 619-297-1750
Practice Fax: 619-297-0470

1437249075 — MRS. NIRMALA AUERBACH RD
Practice Location Address:

7214 ADAIR POST
SAN ANTONIO, TX
78250-6298

Practice Phone: 210-481-6519
Practice Fax: 210-481-6519

Directions to “ MISS KIMBERLY EILEEN WAGNER M.A.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.