Individual
MATTHEW WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4600 47TH AVE STE 111, SACRAMENTO, CA 95824-3923
(916) 393-1222
Mailing address
10741 FAIR OAKS BLVD APT 110, FAIR OAKS, CA 95628-7903
(916) 965-5190
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
174400000X
Specialist
—
—
372600000X
Adult Companion
Primary
—
CA
Other
Enumeration date
10/27/2006
Last updated
06/04/2025
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