Individual
DOUGLAS WAGEMANN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
32392 COAST HWY STE 250, LAGUNA BEACH, CA 92651-6776
(949) 499-2265
Mailing address
32392 COAST HWY STE 250, LAGUNA BEACH, CA 92651-6776
(949) 499-2265
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95055166
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95011040
CA
Other
Enumeration date
03/12/2015
Last updated
03/01/2020
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