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Contact Information

STACY WAGNER
27216 REGIO
MISSION VIEJO, CA92692-3287
 Phone: 513-377-7938
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Gerontological

133VN1101X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for STACY WAGNER · (Female)

NPI Number 1679444756
Status Active
Credentials
Entity Individual
Enumeration date 09/13/2025
Last updated 09/13/2025 - About 9 months ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 926900
  • CA License # 936900
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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