Provider Demographics
NPI:1699930966
Name:VERONICA WAGNER INC
Entity type:Organization
Organization Name:VERONICA WAGNER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:HELGA
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN CNM
Authorized Official - Phone:831-689-9073
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-0475
Mailing Address - Country:US
Mailing Address - Phone:831-689-9073
Mailing Address - Fax:831-689-9351
Practice Address - Street 1:2435 FOREST AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:831-689-9073
Practice Address - Fax:831-689-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484636163W00000X
CA1048367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty