Individual
JUSTIN PHILIP WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 UCLA MEDICAL PLZ # 265, LOS ANGELES, CA 90095-8344
(310) 206-2429
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A117746
CA
2086S0120X
Pediatric Surgery Physician
Primary
A117746
CA
Other
Enumeration date
04/07/2010
Last updated
11/05/2019
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