Individual
CRAIG PHILLIP WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
555 POINTE DR STE 314, BREA, CA 92821-3651
(714) 672-9470
Mailing address
555 POINTE DR STE 314, BREA, CA 92821-3651
(714) 672-9470
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
16195
CA
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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