Provider Demographics
NPI:1871473371
Name:WAGNER, LAURENT (RN)
Entity type:Individual
Prefix:
First Name:LAURENT
Middle Name:
Last Name:WAGNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 W 228TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5106
Mailing Address - Country:US
Mailing Address - Phone:424-325-3368
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 315
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1053
Practice Address - Country:US
Practice Address - Phone:424-325-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818030163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy