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Individual

MR. BRIAN WAGONER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
DANA ELISE SOLUTIONS, LLC., 450 NORTH BEDFORD DRIVE, SUITE 200, BEVERLY HILLS, CA 90210
(310) 550-5566
(310) 861-1164
Mailing address
450 NORTH BEDFORD DRIVE, SUITE 200, BEVERLY HILLS, CA 90210
(714) 580-9186
(310) 861-1164

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L9626

Other

Enumeration date
04/26/2023
Last updated
04/26/2023
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