Wagner, Mark S

Wagner, Mark S is an sole proprietor health care provider with primary practice located at 515 Cabrillo Park Dr Suite 120, Santa Ana CA 92701-5016. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Wagner, Mark S can be contacted via phone (714) 558-8038.

Contact Information

Primary practice address
515 Cabrillo Park Dr Suite 120 Santa Ana CA 92701-5016
Phone: (714) 558-8038
Fax: (714) 558-6033
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X G42267 California
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X G42267 California
Allopathic & Osteopathic Physicians / Addiction Medicine 2084A0401X G42267 California

Profile Details

NPI number 1700821709
LBN Legal business name Wagner, Mark S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 17th, 2006
Last updated Sep 1st, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700821709 NPPES
California MEDICAID 00G422670

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