Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Luke Andrew Wagner, SOIDC

Individual provider Independent Duty Corpsman · NPI 1013589407

Luke Andrew Wagner, SOIDC is an Independent Duty Corpsman in Coronado, California. Registered with an NPI since 2021.

In the registry since
2021
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Practice location Address checks out

917 3rd St
Coronado, CA 92118-1313
Phone: (305) 793-4777
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Independent Duty Corpsman (primary) Taxonomy 1710I1002X

Record details

NPI number1013589407
Entity typeIndividual (Type 1)
GenderMale
Credentials SOIDC
Sole proprietorNo
NPI enumeratedJuly 14, 2021
Last updated in NPPESJuly 14, 2021
Certification dateJuly 14, 2021
Mailing address917 3rd St, Coronado, CA 92118-1313

Other providers in Coronado