Healthcare Provider Details

I. General information

NPI: 1487441085
Provider Name (Legal Business Name): CHRISTOPHER WAGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRAND BLVD LOS PRADOS APT 33201
CAGUAS PR
00727-3445
US

IV. Provider business mailing address

500 GRAND BLVD LOS PRADOS APT 33201
CAGUAS PR
00727-3445
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-1025
  • Fax:
Mailing address:
  • Phone: 787-409-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25164
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: