Individual
NATHAN ELI WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6000
Mailing address
2853 ORO BLANCO CIR, ESCONDIDO, CA 92027-5257
(951) 733-6572
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
D7208222
CA
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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