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General NPI Number Information
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NPI Number | 1538823760
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Entity Type | Individual
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Provider Name | AMELIE C WAGNER MD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 40700 CALIFORNIA OAKS RD STE 208
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City | MURRIETA
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State | CA
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Zip | 92562-5789
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Country | US
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Telephone | 888-858-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 3425 RUE DU PARC
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City | CANTON-DE-HATLEY
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State | QUEBEC
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Zip | J0B2C0
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 310589-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A176166
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License Number State | CA
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