Individual
DR. ALLAN KOSUKE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2721 E MAIN ST, VENTURA, CA 93003-2803
(805) 667-2841
(805) 667-2846
Mailing address
147 N BRENT ST, VENTURA, CA 93003-2809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A18045
CA
Other
Enumeration date
06/25/2018
Last updated
06/28/2021
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