Individual
HILLARY J WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11234 ANDERSON ST, GME OFFICE WESTERLY SUITE 'C', LOMA LINDA, CA 92354-2804
(909) 558-4289
Mailing address
11234 ANDERSON ST, GME OFFICE WESTERLY SUITE 'C', LOMA LINDA, CA 92354-2804
(909) 558-4289
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
PENDING
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2014
Last updated
12/30/2024
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