Kristine Tiffany Wagner, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY18320 Issued in CA

Practice address

27393 Ynez Rd
Suite 153
Temecula, CA 92591-5604

Phone

(951) 695-7400

Fax

(951) 695-7144

NPI assigned

Jul 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kristine T. Wagner, PH.D, Inc.

  • Clinical Psychologist
  • Temecula, CA
  • NPI 1558461749
  NPD (past) Authorized official

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902837255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 892143",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925892143",
            "telephone_number": "951-695-7400",
            "fax_number": "951-695-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27393 YNEZ RD",
            "address_2": "SUITE 153",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925915604",
            "telephone_number": "951-695-7400",
            "fax_number": "951-695-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KRISTINE",
        "middle_name": "TIFFANY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY18320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wade Faerber D.O., a Medical Corporation
• Shirley K Wade
• Valarie Wade
• Cali Waggoner
• Jeanine Christine Wagner, FNP
• Maricris Edilloran Wagner, RPH
• Felicia Wakeland
• Abida Zohal Wali, N.D.
• Walk Run Randall
• Angela Walker

• Clinical Neuropsychologist in Temecula, CA
• Providers in Temecula, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.