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1700371523
ALLAN KOSUKE WAGNER
VENTURA, CA
NPI
1700371523
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: CA 20A18045)
Enumeration Date
2018-06-25
Last Update Date
2021-06-28
Business Address
Dr. ALLAN KOSUKE WAGNER DO
2721 E MAIN ST
VENTURA, CA 93003-2803
Phone number: 805-667-2841
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Mailing Address
Dr. ALLAN KOSUKE WAGNER DO
147 N BRENT ST
VENTURA, CA 93003-2809
Phone number:
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