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General NPI Number Information
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NPI Number | 1871141598
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Entity Type | Organization
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Legal Business Name | EDWARD A, WAGNER, M.D., INC.
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 25500 RANCHO NIGUEL RD STE 240
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7373
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Country | US
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Telephone | 949-923-5117
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Fax | 949-715-4827
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Provider Business Mailing Address
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Address Line | 25500 RANCHO NIGUEL RD STE 240
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7373
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Country | US
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Telephone | 949-499-4540
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Fax | 949-715-4827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD A WAGNER
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Credential | MD
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Telephone | 949-499-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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