Lucille Marie Wagner, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT6997 Issued in CA

Practice address

17456 Beach Blvd
Huntington Beach, CA 92647-5913

Phone

(714) 841-2688

Fax

(714) 841-2688

NPI assigned

Nov 30, 2006

Last updated

Sep 10, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Lucille Marie Lopez Wagner Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284076800000",
    "number": "1841368768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3079 NESTALL RD",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512026",
            "telephone_number": "949-497-8227",
            "fax_number": "714-841-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17456 BEACH BLVD",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926475913",
            "telephone_number": "714-841-2688",
            "fax_number": "714-841-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LUCILLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC3506",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT6997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LUCILLE",
            "last_name": "WAGNER",
            "middle_name": "MARIE LOPEZ",
            "credential": "L.AC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mandy Huynh Vuong, DDS
• Cyndi Binh Vuu
• Marianne Wade, R.N.
• Edna Waggoner
• Emily Wagner
• Rachel Wagner
• Jan Louise Wagniere, LCSW, MFC
• Krista Wagnon, LPCC
• Christy E Wahrer, LISW
• Emile P. Wakim, M.D.

• Physical Therapist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.