Individual
CHASE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
1955 CITRACADO PKWY, SUITE 300, ESCONDIDO, CA 92029-4110
(760) 743-0546
(760) 743-8005
Mailing address
15611 POMERADO RD, FIFTH FLOOR, POWAY, CA 92064-2437
(858) 673-2574
(858) 618-1523
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95004029
CA
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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