MARK S WAGNER MD NPI 1700821709

NPI Information

NPI: 1700821709
Provider Name: MARK S WAGNER, MD
Classification: General Practice - 208D00000X
Entity Type: Individual
Address:
515 CABRILLO PARK DR
SUITE 120
SANTA ANA, CA
ZIP 92701
Phone: (714) 558-8038
Get Directions

Mark S Wagner, MD is a general practice in Santa Ana, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Mark S Wagner, MD NPI is 1700821709. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

515 CABRILLO PARK DR
SUITE 120
SANTA ANA, CA
ZIP 92701-016
Phone: (714) 558-8038
Fax: (714) 558-6033

The enumeration date for this NPI number is 6/17/2006 and was last updated on 9/1/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208VP0000X	Pain Medicine	Pain Medicine	G42267	CALIFORNIA	No
2	2084A0401X	Psychiatry & Neurology	Addiction Medicine	G42267	CALIFORNIA	No
3	208D00000X	General Practice		G42267	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	00G422670	MEDICAID	CALIFORNIA
2	A48890	MEDICARE UPIN
3	HG42267A	MEDICARE PIN	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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