NPI 1013589407

Luke Andrew Wagner, SOIDC

Practitioner Independent Duty Corpsman Coronado, CA

Practice location

Address: 917 3rd St, Coronado, CA 92118-1313
Phone: (305) 793-4777

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1013589407
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Jul 2021
Record last updated: 14 Jul 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.