Individual
JOHN WAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2485 HOSPITAL DR, SUITE #351, MOUNTAIN VIEW, CA 94040-4101
(650) 687-7322
(650) 988-7674
Mailing address
2485 HOSPITAL DR, SUITE #351, MOUNTAIN VIEW, CA 94040-4101
(650) 687-7322
(650) 988-7674
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
23806
CA
103T00000X
Psychologist
23806
CA
103TC0700X
Clinical Psychologist
23806
CA
103TR0400X
Rehabilitation Psychologist
23806
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46-3467093
TAX IDENTIFICATION
CA
Enumeration date
05/28/2007
Last updated
11/11/2015
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