PERRY WAGNER

LONG BEACH, CA
NPI1700179520
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2011-05-26
Last Update Date2011-05-26
Business Address
-- PERRY WAGNER RASi
100 E MARKET ST
LONG BEACH, CA 90805-5924
Phone number: 562-428-4222
Mailing Address
-- PERRY WAGNER RASi
2075 E BROADWAY APT 206
LONG BEACH, CA 90803-6231
Phone number: 909-244-6918
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