Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E2415 | CA |
N | 222Z00000X | Podiatrist | E2415 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E2415 | CA |
N | 111NR0200X | Radiology | E2415 | CA |
N | 213ER0200X | Radiology | E2415 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E2415 | CA |
NPI | 1043213242 |
---|---|
Provider Name | Dr. Carl Wagreich |
First Address | Torrance, CA 90505-4761 |
Second Address | Torrance, CA 90505-4761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 30/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E24150 | (05) | CA |
T19194 | (02) | CA |