Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1255412615 |
---|---|
Provider Name | Mr. James Allen Wagner |
First Address | Bakersfield, CA 93309-5386 |
Second Address | Los Angeles, CA 90073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |