Individual
ELIZABETH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CCN
Contact information
Practice address
1224 10TH ST STE 207, CORONADO, CA 92118-3420
(619) 437-6600
(619) 437-6603
Mailing address
1224 10TH ST STE 207, CORONADO, CA 92118-3420
(619) 437-6600
(619) 437-6603
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
12/07/2007
Last updated
04/01/2011
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