Type | Person | [sources] | |||
---|---|---|---|---|---|
Name | Talia Mays Wagner | [sources] | |||
Other name | Wagner, Allen P | [sources] | |||
Birth date | not available | [sources] | |||
Nationality | not available | [sources] | |||
Country | United States of America | [sources] | |||
First name | Talia | [sources] | |||
Last name | Wagner | [sources] | |||
Middle name | Mays | [sources] | |||
NPI | 1386775468 | [sources] | |||
Registration number | 46414 | [sources] | |||
Sector | Licensed Marriage and Family Therapist | [sources] | |||
Address | 1110 N Virgil Ave, Los Angeles, CA 90029 | [sources] | |||
Last change | Last processed | First seen |
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States of America · DHCS
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