MEDICARE: GUY WANGENSTEEN

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	101Y00000X	Counselor	56878	CA

General Provider Information

NPI Number	:	1225308547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY WANGENSTEEN

Provider Business Mailing Address
First Line	:	131 N LYON ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 N LYON ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5121
Country	:	US
Telephone Number	:	562-921-0549
Fax Number	:

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

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	05/10/2012

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Directions to “ GUY WANGENSTEEN ” Practice Location

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