Individual
KRISTINE TIFFANY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
27393 YNEZ RD, SUITE 153, TEMECULA, CA 92591-5604
(951) 695-7400
(951) 695-7144
Mailing address
PO BOX 892143, TEMECULA, CA 92589-2143
(951) 695-7400
(951) 695-7144
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY18320
CA
Other
Enumeration date
07/05/2006
Last updated
07/08/2007
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